Abstract 10954: Average Annual Out-of-Pocket Cost of Guideline Directed Medical Therapy for Heart Failure

Abstract

Introduction: The 2022 multi-society heart failure guidelines underscore the importance of initiating and maintaining patients on Guideline Directed Medical Therapy (GDMT). Cost transparency plays a key role in the shared-decision making process, however, national estimates of out-of-pocket (OOP) cost for GDMT for Heart Failure (HF) are lacking Methods: Using data from the Medical Expenditure Panel Survey (MEPS) 2019, we estimated the average annual OOP cost for each GDMT drug class: cardio-selective Beta-Blockers (BB), Angiotensin-converting enzyme inhibitors (ACEi)/Angiotensin II receptor blockers (ARB)/Angiotensin Receptor-Neprilysin Inhibitor (ARNi), Mineralocorticoid Receptor Antagonists (MRA), and Sodium-glucose cotransporter-2 inhibitors (SGLT2i). We also estimated average annual OOP costs for recommended GDMT combinations: Quadruple therapy, quadruple with ARNI alone, and various combinations of triple therapy. Cost estimates were also stratified by insurance status. Results: Of 28,512 MEPS participants, we found 1,954 with a prescription for a BB, 3,642 with at least 1 script for an ACEi/ARB, 42 participants on ARNI, 280 with at least 1 script for an MRA, and 140 with at least 1 script for an SGLT2i. Average annual OOP costs for each GDMT drug class was: $41 (95%CI $34-$48) for BB, $29 (95%CI $26-$32) for ACEi/ARB, ARNi alone estimated at $192 (95%CI $111-$274), $32 (95%CI $25-$39) for MRA, and $151 (95%CI $110-$191) for SGLT2i. The average annual OOP cost for quadruple therapy in 2019 was $253, $292 for privately insured, $159 for those on public insurance, and $975 for the uninsured. Quadruple therapy with ARNI alone on average added ~$200 to the annual OOP cost. For triple therapies, a combination of MRA, BB, and ACEi/ARB was $282 less compared to a combination of BB, ARNI, and SGLT2i. Conclusions: The average annual OOP for GDMT was substantially mitigated by insurance coverage. Including estimates of GDMT cost and the protective role of health insurance coverage in the shared decision-making process might increase the proportion of heart failure patients initiated and maintained on GDMT.