This study evaluated the association between sacubitril/valsartan utilization and HF patients' Part A \& B expenditures within the reimbursement framework of BPCI and MSSP, and identified BPCI/MSSP participants with the greatest potential for performance improvement (with respect to improving quality and efficiency of care for HF patients) through optimized utilization of sacubitril/valsartan.
This drug utilization study employed a retrospective cohort design using the 100% files of 2015-2018 Medicare enrollment and Part A, B \& D claims data in conjunction with publicly available information on providers participating in Bundled Payments for Care Improvement (BPCI) and/or Medicare Shared Savings Program (MSSP). BPCI Study Design The unit of analysis for addressing study objectives was a unique Congestive Heart Failure (CHF) episode of care, which encompassed an initial acute inpatient stay plus all Part A \& B covered medical services during the 90 days post hospital discharge. Episode index date was defined as the date of a beneficiary's initial acute hospital stay with a qualifying Medicare Severity-Diagnosis Related Group (MS-DRG) for CHF, triggering a CHF episode of care. Beneficiaries were followed longitudinally from episode index date through episode end date to measure their utilization of sacubitril/valsartan and Part A \& B expenditures during the CHF episode of care. A 12-month lookback period, based on when the episode was initiated, was utilized to capture beneficiaries' baseline characteristics. For example, episodes initiated on 2/1/2018 will have a 2/1/2017 to 1/31/2018 baseline lookback period. Balancing the need for data recency, all qualifying CHF episodes from 2016-2018 were included in the analysis. Given this is an episode-level analysis, a beneficiary may have contributed multiple CHF episodes to the data analysis. To account for potential within-subject clustering, a generalized linear model with a gamma distribution was applied for estimating the association between sacubitril/valsartan use and CHF episode costs. MSSP Study Design The unit of analysis for addressing study objectives was a HF patient's Part A \& B expenditures within the MSSP. Given the most recent year of data available at the time the study was conducted was 2018, the study population included HF patients for whom the MSSP participants were accountable in 2018 per Centers for Medicare \& Medicaid Services (CMS) assignment. These beneficiaries' utilization of sacubitril/valsartan and annual Part A \& B expenditures was measured from January 1, 2018 - December 31, 2018. Data from CY 2017 was leveraged for capturing these patients' baseline characteristics.
Study Type
OBSERVATIONAL
Enrollment
1,614,719
Beneficiaries with one or more prescription claim with an NDC for sacubitril/valsartan (from the PDE file) during the 90-day episode window. Patients who met these criteria were assigned a value of '1'; patients that did not meet these criteria were assigned a value of '0'
Beneficiaries with one or more prescription claim with an NDC for any ACEI/ARB and no prescription claims for sacubitril/valsartan during the 90-day episode window. Patients who met these criteria were assigned a value of '1'; patients that did not meet these criteria were assigned a value of '0'
Novartis Pharmaceuticals
East Hanover, New Jersey, United States
Bundled Payments for Care Improvement (BPCI) Congestive Heart Failure (CHF) episode costs
BPCI CHF episode costs defined as the sum of expenditures for Part A \& B covered medical services during the CHF episode
Time frame: 90 days following the episode index date (episode index date differed by patient depending on when they were admitted to the hospital (triggering a HF clinical episode), ranging from Jan. 1, 2016 through Oct. 1, 2018)
Medicare Shared Savings Program (MSSP) beneficiary annual Medicare
MSSP beneficiary annual Medicare Part A \& B expenditures defined as the sum of all Part A \& B expenditures within the calendar year (CY)
Time frame: Baseline (Calender Year 2017) and Calender Year 2018 (01/01/2018 to 31/12/2018)
Outpatient utilization of sacubitril/valsartan during 90-day post-discharge period of the CHF episode
yes/no binary variable
Time frame: 90 days following the episode index date (episode index date differed by patient depending on when they were admitted to the hospital (triggering a HF clinical episode), ranging from Jan. 1, 2016 through Oct. 1, 2018)
Difference in actual Congestive Heart Failure (CHF) episode costs vs. benchmark CHF episode costs
A benchmark was created to assess performance and determine savings for the BPCI. Difference in actual Congestive Heart Failure (CHF) episode costs vs. benchmark CHF episode costs were reported
Time frame: 90 days following the episode index date (episode index date differed by patient depending on when they were admitted to the hospital (triggering a HF clinical episode), ranging from Jan. 1, 2016 through Oct. 1, 2018)
Outpatient utilization of sacubitril/valsartan among Medicare Shared Savings Program (MSSP) Heart Failure (HF) patients
yes/no binary variable
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Time frame: Baseline (Calender Year 2017) and Calender Year 2018 (01/01/2018 to 31/12/2018)
Difference in actual HF patient annual Medicare Part A & B expenditures vs. benchmark HF patient annual Medicare Part A & B expenditures
A benchmark was created to assess performance and determine savings for the MSSP. Difference in actual HF patient annual Medicare Part A \& B expenditures vs. benchmark HF patient annual Medicare Part A \& B expenditures were reported
Time frame: Baseline (Calender Year 2017) and Calender Year 2018 (01/01/2018 to 31/12/2018)