Background: The US Food and Drug Administration approved the use of sacubitril/valsartan in patients with heart failure with reduced ejection fraction in July 2015. We aimed to assess the adoption and prescription drug costs of sacubitril/valsartan in its first 18 months after Food and Drug Administration approval.

Methods and Results: Using a large US insurance database, we identified privately insured and Medicare Advantage beneficiaries who filled a first prescription for sacubitril/valsartan between July 1, 2015, and December 31, 2016. We compared them to patients treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Outcomes included adoption, prescription drug costs, and 180-day adherence, defined as a proportion of days covered ≥80%. A total of 2244 patients initiated sacubitril/valsartan. Although the number of users increased over time, the proportion of heart failure with reduced ejection fraction patients taking sacubitril/valsartan remained low (<3%). Patients prescribed sacubitril/valsartan were younger, more often male, with less comorbidity than those taking an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Although a majority of prescription costs were covered by the health plan (mean, $328.37; median, $362.44 per 30-day prescription), out-of-pocket costs were still high (mean, $71.16; median, $40.27). By comparison, median out-of-pocket costs were $2 to $3 for lisinopril, losartan, carvedilol, and spironolactone. Overall, 59.1% of patients were adherent to sacubitril/valsartan. Refill patterns suggested that nearly half of nonadherent patients discontinued sacubitril/valsartan within 180 days of starting.

Conclusions: Adoption of sacubitril/valsartan after Food and Drug Administration approval has been slow and may be associated with the high cost.

背景： 2015年7月，美国食品药品监督管理局（US Food and Drug Administration）批准将沙必比尔/缬沙坦用于心力衰竭患者，其射血分数降低。药品管理局批准。

方法和结果：通过使用大型美国保险数据库，我们确定了在2015年7月1日至2016年12月31日期间开具沙奎特利/缬沙坦第一个处方的私人保险人和Medicare Advantage受益人。我们将它们与接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。结果包括采用率，处方药费用和180天依从性，定义为覆盖80％以上的天数。共有2244例患者开始使用沙比特利/缬沙坦治疗。尽管使用人数随着时间的推移而增加，但服用沙必特/缬沙坦的射血分数降低的心力衰竭的比例仍然较低（<3％）。开具沙奎普利/缬沙坦的患者年龄较小，男性较多，与使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的合并症相比，合并症的发病率更低。尽管医疗计划涵盖了大多数处方费用（平均为328.37美元；中位数为每30天处方362.44美元），但自付费用仍然很高（平均为71.16美元；中位数为40.27美元）。相比之下，赖诺普利，氯沙坦，卡维地洛和螺内酯的自付费用中位数为2至3美元。总体而言，有59.1％的患者坚持接受屈比特尔/缬沙坦治疗。补充模式表明，将近一半的非依从性患者在开始治疗后的180天内停用了沙比特利/缬沙坦。赖诺普利，氯沙坦，卡维地洛和螺内酯的自付费用中位数为2至3美元。总体而言，有59.1％的患者坚持接受屈比特尔/缬沙坦治疗。补充模式表明，将近一半的非依从性患者在开始治疗后的180天内停用了沙比特利/缬沙坦。赖诺普利，氯沙坦，卡维地洛和螺内酯的自付费用中位数为2至3美元。总体而言，有59.1％的患者坚持接受屈比特尔/缬沙坦治疗。补充模式表明，将近一半的非依从性患者在开始治疗后的180天内停用了沙比特利/缬沙坦。

结论：在食品和药物管理局批准后，使用沙必比尔/缬沙坦的速度缓慢，可能与成本高有关。