Counter cost concerns with heartworm treatment

The recently updated American Heartworm Society (AHS) canine heartworm guidelines emphasize the advantages of the protocol over the non-arsenical treatment protocols that have been studied in the U.S. and Europe. While these protocols are needed for dogs that aren't candidates for melarsomine treatment, the hope is that most heartworm-positive dogs can undergo the AHS treatment regimen, which is designed to eliminate the highest percentage of adult worms while minimizing treatment complications.

So, you have the better protocol and access to medications. What can you do to make sure the pet owner isn't put off by cost or a weak recommendation?

Countering cost concerns with adulticide treatment

There's no getting around it: While heartworm preventives are affordable, heartworm treatments can be quite expensive. It's not unusual for clients to develop a case of sticker shock when presented with the anticipated costs. Here's how I work with owners of heartworm-positive dogs to help make the cost of treatment more manageable:

Create a step-by-step estimate that breaks down the treatment steps. Treatment estimates that break out the different costs can help clients understand the complexity of treatment as well as the total cost. Owners understand that fees are associated with lab tests and imaging as well as with medications, monitoring and-in some instances-hospitalization. (Editor's note: Worried that if you list all the specific costs that clients will argue to knock some of them off? Itemize the parts of the treatment but don't include individual prices.)

Create a payment plan that mirrors the treatment plan. One benefit to the AHS treatment protocol is that the medications are administered in a step-by-step fashion. Because there are 60 days between the initial diagnosis and the first melarsomine injection-as well as another 30 days between the first and second injections-payments can be billed in tandem with the medication. This also gives the client the opportunity to save for the costliest component of treatment: the melarsomine injections.

Use third-party payment plans. For clients who aren't enrolled in a pet health insurance plan or who can't afford to pay as they go, programs like CareCredit and Scratchpay can help owners stretch out the treatment costs in a manageable payment schedule.

Putting the brakes on slow kill

Many clients today research pet healthcare issues, so it's not uncommon for them to learn about-and ask for-a slow-kill alternative to melarsomine treatment. While it may be tempting for veterinarians to offer alternative protocols to clients on tight budgets, forgoing adulticide treatment is not always in the long-term best interest of the pet. Here's how I handle it:

• Explain the risks of slow kill. Because it can take years or more for alternative protocols to achieve results, the progression of pulmonary pathology and damage from adult heartworms continues over an extended period of time. Most clients want what's best for their pet; we do our clients a disservice if we don't provide our best recommendation first.
• Compare the costs. While non-arsenical protocols eliminate the cost of melarsomine, they aren't necessarily cheap. Doxycycline-which should be used in non-arsenical as well as adulticide regimes to kill Wolbachia species bacteria and reduce the reproductive potential of adult heartworms-is a fairly expensive antibiotic. Meanwhile, dogs on non-arsenical therapy require repeated antigen tests to ascertain their status.

Just make sure with any change in protocols that you and your team are on the same page on the importance of the change if it affects what pet owners are paying. This is about strong recommendations and strong communication. In my view, good medicine is always good business, and maintaining standards of integrity keeps our patients healthier-and our clients happier-in the long run.

Dr. Chris Duke is founder of Bienville Animal Medical Center in Ocean Springs, Mississippi.