Rung Jillian M, Barrett Tyson S, LeJeune Keith, Richards Shannon B, Raina Amresh, Sinoway Lawrence
Enterprise Analytics, Highmark Health, Pittsburgh, Pennsylvania, United States of America.
Allegheny Health Network, Pittsburgh, Pennsylvania, United States of America.
PLoS One. 2025 Mar 25;20(3):e0320216. doi: 10.1371/journal.pone.0320216. eCollection 2025.
The goals of this retrospective cohort analysis were to determine real-world dose and titration patterns of sacubitril/valsartan (SAC/VAL), a heart failure medication, and examine whether dose patterns are associated with healthcare utilization and costs.
Adult health plan members (18-100 years old) who initiated SAC/VAL between 2020 and 2022 and had continuous enrollment 6 months prior to, and at least 3 months following SAC/VAL initiation were identified. Members also had to have 3 months of SAC/VAL fills with good adherence (N = 2,977). Claims data were used to characterize dosage patterns and compare total costs of care, as well as all-cause and heart failure- hospital admissions across those with different terminal SAC/VAL doses.
Most members initiated SAC/VAL at the lowest dose (76%, n = 2,267), of whom few titrated upward by their final fill (31%, n = 703). Overall, only 19% (n = 563) were at target by their final fill. Those ending on higher doses experienced significantly fewer all-cause admissions (incidence rate ratios of 1.52 [SE = .16] to 2.66 [SE = .37]; ps < .001) and incurred significantly lower total costs of care while on SAC/VAL (cost ratios of 1.21 [SE = .06] to 1.48 [SE = .09]; ps < .001).
Most individuals initiate and remain on the lowest SAC/VAL dose despite guidelines to titrate upward. SAC/VAL dosage is significantly associated with outcomes, with higher doses associated with more clinical and cost benefits. Research is needed to identify barriers to dose titration and to develop interventions for maximal patient benefit.
本回顾性队列分析的目的是确定心力衰竭药物沙库巴曲缬沙坦（SAC/VAL）的实际用药剂量和滴定模式，并研究剂量模式是否与医疗保健利用和成本相关。
确定2020年至2022年间开始使用SAC/VAL且在开始使用SAC/VAL前6个月和开始使用后至少3个月持续参保的成年健康计划成员（18至100岁）。成员还必须有3个月的SAC/VAL配药记录且依从性良好（N = 2977）。索赔数据用于描述剂量模式，比较护理总成本，以及不同最终SAC/VAL剂量患者的全因和心力衰竭住院情况。
大多数成员以最低剂量开始使用SAC/VAL（76%，n = 2267），其中很少有人在最后一次配药时向上滴定剂量（31%，n = 703）。总体而言，只有19%（n = 563）的人在最后一次配药时达到目标剂量。最终使用较高剂量的患者全因住院次数显著减少（发病率比值为1.52[标准误 = 0.16]至2.66[标准误 = 0.37]；p值 < 0.001），并且在使用SAC/VAL期间的护理总成本显著降低（成本比值为1.21[标准误 = 0.06]至1.48[标准误 = 0.09]；p值 < 0.001）。
尽管有向上滴定剂量的指南，但大多数人开始并维持使用最低剂量的SAC/VAL。SAC/VAL剂量与治疗结果显著相关，较高剂量与更多临床和成本效益相关。需要开展研究以确定剂量滴定的障碍，并制定干预措施以使患者获得最大益处。
