TY - JOUR
T1 - Contemporary Patterns of Medicare and Medicaid Utilization and Associated Spending on Sacubitril/Valsartan and Ivabradine in Heart Failure
AU - Sumarsono, Andrew
AU - Vaduganathan, Muthiah
AU - Ajufo, Ezimamaka
AU - Navar, Ann Marie
AU - Fonarow, Gregg C.
AU - Das, Sandeep R.
AU - Pandey, Ambarish
N1 - Funding Information:
Conflict of Interest Disclosures: Dr Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/NCATS Award UL 1TR002541), serves on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, and Relypsa, and participates on clinical end point committees for studies sponsored by Novartis and the National Institutes of Health. Dr Fonarow reports significant consulting for Novartis and modest consulting for Abbott, Amgen, Bayer, CHF Solutions, Janssen, and Medtronic. Dr Pandey is supported by the Texas Health Resources Clinical Scholars Program. Dr Navar reported grants and personal fees from Amgen, Amarin, Sanofi, Regeneron, and Janssen and personal fees from Novo Nordisk and AstraZeneca outside the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2020/3
Y1 - 2020/3
N2 - Importance: In 2015, the US Food and Drug Administration approved 2 new medications for treatment of heart failure with reduced ejection fraction, sacubitril/valsartan and ivabradine. However, few national data are available examining their contemporary use and associated costs. Objective: To evaluate national patterns of use of sacubitril/valsartan and ivabradine and associated therapeutic spending in Medicare Part D and Medicaid. Design, Setting, and Participants: In this US nationwide claims-based study, we analyzed data from the Medicare Part D Prescription Drug Event and Medicaid Utilization and Spending data sets to compare national patterns of use of sacubitril/valsartan and ivabradine between 2016 and 2017. Main Outcomes and Measures: Changes in total spending, per-beneficiary/claim spending, number of beneficiaries, and number of claims between 2016 and 2017 for sacubitril/valsartan and ivabradine. Results: The number of Medicare beneficiaries prescribed sacubitril/valsartan increased from 35423 to 90606 (156% increase from 2016 to 2017). Medicare beneficiaries prescribed ivabradine increased from 15856 to 23213 (46% increase). In 2017, Medicare Part D spent $227 million and $7.3 million on sacubitril/valsartan and ivabradine, respectively. This represented increases of 241% and 59% compared with 2016 spending, respectively. The annual Medicare per-beneficiary spending on sacubitril/valsartan and ivabradine was $2512 and $2400. Parallel trends in use patterns and spending were observed among Medicaid beneficiaries. Conclusions and Relevance: Although initial experiences suggested slow uptake after regulatory approval, these national data demonstrate an increase in use of sacubitril/valsartan and, to a lesser degree, ivabradine in the United States. Current annual per-beneficiary expenditures remain less than spending thresholds that have been reported to be cost-effective. Ongoing efforts are needed to promote high-value care while improving affordability and access to established and emerging heart failure therapies.
AB - Importance: In 2015, the US Food and Drug Administration approved 2 new medications for treatment of heart failure with reduced ejection fraction, sacubitril/valsartan and ivabradine. However, few national data are available examining their contemporary use and associated costs. Objective: To evaluate national patterns of use of sacubitril/valsartan and ivabradine and associated therapeutic spending in Medicare Part D and Medicaid. Design, Setting, and Participants: In this US nationwide claims-based study, we analyzed data from the Medicare Part D Prescription Drug Event and Medicaid Utilization and Spending data sets to compare national patterns of use of sacubitril/valsartan and ivabradine between 2016 and 2017. Main Outcomes and Measures: Changes in total spending, per-beneficiary/claim spending, number of beneficiaries, and number of claims between 2016 and 2017 for sacubitril/valsartan and ivabradine. Results: The number of Medicare beneficiaries prescribed sacubitril/valsartan increased from 35423 to 90606 (156% increase from 2016 to 2017). Medicare beneficiaries prescribed ivabradine increased from 15856 to 23213 (46% increase). In 2017, Medicare Part D spent $227 million and $7.3 million on sacubitril/valsartan and ivabradine, respectively. This represented increases of 241% and 59% compared with 2016 spending, respectively. The annual Medicare per-beneficiary spending on sacubitril/valsartan and ivabradine was $2512 and $2400. Parallel trends in use patterns and spending were observed among Medicaid beneficiaries. Conclusions and Relevance: Although initial experiences suggested slow uptake after regulatory approval, these national data demonstrate an increase in use of sacubitril/valsartan and, to a lesser degree, ivabradine in the United States. Current annual per-beneficiary expenditures remain less than spending thresholds that have been reported to be cost-effective. Ongoing efforts are needed to promote high-value care while improving affordability and access to established and emerging heart failure therapies.
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U2 - 10.1001/jamacardio.2019.4982
DO - 10.1001/jamacardio.2019.4982
M3 - Article
C2 - 31738371
AN - SCOPUS:85075251414
VL - 5
SP - 336
EP - 339
JO - JAMA Cardiology
JF - JAMA Cardiology
SN - 2380-6583
IS - 3
ER -