Grace E Venechuk1,2, Larry A Allen1,3, Katherine Doermann Byrd4, Neal Dickert5,6,7, Daniel D Matlock1,8,9. 1. Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., L.A.A., D.D.M.), University of Colorado School of Medicine, Aurora. 2. Center for Demography of Health and Aging, University of Wisconsin-Madison (G.E.V.). 3. Division of Cardiology (L.A.A.), University of Colorado School of Medicine, Aurora. 4. American College of Cardiology, Washington, DC, (K.D.B.). 5. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, GA (N.D.). 6. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.D.). 7. Emory Center for Ethics, Atlanta, GA (N.D.). 8. Division of Geriatric Medicine (D.D.M.), University of Colorado School of Medicine, Aurora. 9. Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver (D.D.M.).
Abstract
BACKGROUND: Despite concerns about rising costs in health care, cost is rarely an issue discussed by patients and clinicians when making treatment decisions in a clinical setting. This study aimed to understand stakeholder perspectives on a patient decision aid (PtDA) meant to help patients with heart failure choose between a generic and relatively low-cost heart failure medication (ACE [angiotensin-converting enzyme] inhibitor or angiotensin II receptor blocker) and a newer, but more expensive, heart failure medication (angiotensin II receptor blocker neprilysin inhibitor). METHODS AND RESULTS: Feedback on the PtDA was solicited from 26 stakeholders including patients, clinicians, and the manufacturer. Feedback was recorded and discussed among development team members until consensus regarding both the interpretation of the data and the appropriate changes to the PtDA was reached. Stakeholders found the PtDA sufficient in clarifying the different treatment options for heart failure. However, patients, physicians, and the manufacturer had different opinions on the importance of highlighting cost in a PtDA. Patients indicated issues of cost were crucial to the decision while physicians and manufacturers expressed that the cost issue was secondary and should be de-emphasized. CONCLUSIONS: The stratified perspectives on the role of cost in medical decision-making expressed by our participants underscore the importance and challenge of having clear, frank discussions during clinic visits about treatment cost and perceived value.
BACKGROUND: Despite concerns about rising costs in health care, cost is rarely an issue discussed by patients and clinicians when making treatment decisions in a clinical setting. This study aimed to understand stakeholder perspectives on a patient decision aid (PtDA) meant to help patients with heart failure choose between a generic and relatively low-cost heart failure medication (ACE [angiotensin-converting enzyme] inhibitor or angiotensin II receptor blocker) and a newer, but more expensive, heart failure medication (angiotensin II receptor blocker neprilysin inhibitor). METHODS AND RESULTS: Feedback on the PtDA was solicited from 26 stakeholders including patients, clinicians, and the manufacturer. Feedback was recorded and discussed among development team members until consensus regarding both the interpretation of the data and the appropriate changes to the PtDA was reached. Stakeholders found the PtDA sufficient in clarifying the different treatment options for heart failure. However, patients, physicians, and the manufacturer had different opinions on the importance of highlighting cost in a PtDA. Patients indicated issues of cost were crucial to the decision while physicians and manufacturers expressed that the cost issue was secondary and should be de-emphasized. CONCLUSIONS: The stratified perspectives on the role of cost in medical decision-making expressed by our participants underscore the importance and challenge of having clear, frank discussions during clinic visits about treatment cost and perceived value.
Entities:
Keywords:
clinical decision-making; costs and cost analysis; decision support techniques; economics, medical; patient-centered care
Authors: Neal W Dickert; Andrea R Mitchell; Grace E Venechuk; Daniel D Matlock; Miranda A Moore; Alanna A Morris; Kenneth J Pierce; Candace D Speight; Larry A Allen Journal: Circ Cardiovasc Qual Outcomes Date: 2020-12-11
Authors: Birju R Rao; Candace D Speight; Larry A Allen; Scott D Halpern; Yi-An Ko; Daniel D Matlock; Miranda A Moore; Alanna A Morris; Laura D Scherer; Mary C Thomson; Peter Ubel; Neal W Dickert Journal: J Am Heart Assoc Date: 2022-06-20 Impact factor: 6.106