Patient Experiences and Preferences Regarding Medication Cost Discussions Among Heart Failure Patients in Singapore: A Qualitative Survey.

Purpose: Cost of novel medications has increased worldwide, causing financial toxicity to heart failure patients. Patients can discuss medication costs with clinicians to manage financial burden, but such discussion can be uncommon. This study seeked to investigate the experiences and preferences of heart failure patients in Singapore regarding medication cost discussions to develop effective strategies to encourage such conversations.

Patients and methods: Participants were recruited from a hospital outpatient heart failure clinic in 2022 to participate in a qualitative survey containing open-ended questions. Inclusion criteria were patients aged 21 years and above, diagnosed with heart failure, and capable of comprehending English. There were no exclusion criteria. Conventional content analysis was performed on collected responses.

Results: Among forty-eight heart failure patients (median age: 63.5 years, 43.8% male, 72.9% Chinese) who participated, most (93.8%) wanted to discuss medication costs with clinicians for reasons such as concern over affordability, taking ownership of health, making informed decisions, minimizing inconvenience, and obtaining tailored cost information. Affordability of medications was a concern for patients but only 8.3% of patients actually had regular cost discussions with clinicians in the past year. Patients mentioned a lack of initiative from the clinicians, limited cost awareness, and time constraints as reasons why cost conversations did not happen.

Conclusion: Outpatient heart failure patients in Singapore desire to discuss medication costs with clinicians but few participants reported having such conversations. Barriers hindering cost discussions have to be addressed to ensure patients make an informed medication decision with minimal financial burden.