Abstract 14968: Geographic Variation in the Early Diffusion and of Sacubitril/Valsartan

Abstract

Introduction: In the PARADIGM-HF trial, sacubitril/valsartan demonstrated a 20% reduction in mortality and heart failure (HF) hospitalization compared to enalapril. Despite this success, diffusion has been slower than anticipated. To date, high co-payments have been identified as a key barrier. The aim of this study is to examine the role of geographic prescribing patterns in the early diffusion of sacubitril/valsartan, after controlling for cost. Hypothesis: There will be significant geographic variation in the use of sacubitril/valsartan, after controlling for cost. Methods: We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of beneficiaries with heart failure with reduced ejection fraction (HFrEF) between 2016 and 2018. We calculated age, sex, race adjusted rates of sacubitril/valsartan use by hospital referral region (HRR) and used multivariable logistic regression to determine the association between geographic region and sacubitril/valsartan use, controlling for cost. Results: Early use rates of sacubitril/valsartan have been low: 1.9% in 2016, 3.3% in 2017 and 4% in 2018. There has been substantial geographic variation with most concentrated in the South and Northeast ( Figure ). After controlling for cost, HFrEF patients in the Northeast were 1.32 times (95% CI 1.26-1.29, p<0.001)) more likely, those in the South were 1.24 times more likely (95% CI 1.20-1.29, p<0.001)) and those in the West were 1.10 times more likely (95% CI 1.05-1.15, p<0.001) to receive sacubitril/valsartan compared to HFrEF patients in the Midwest. Conclusions: There has been substantial variation in the early diffusion of sacubitril/valsartan. In addition to cost, geographic prescribing patterns play a major role in early drug diffusion.