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  • Title: Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction.
    Author: Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA.
    Journal: Ann Intern Med; 2016 Nov 15; 165(10):681-689. PubMed ID: 27571284.
    Abstract:
    BACKGROUND: Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction. OBJECTIVE: To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure. DESIGN: Markov decision model. DATA SOURCES: Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables. TARGET POPULATION: Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Treatment with sacubitril-valsartan or lisinopril. OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure. RESULTS OF SENSITIVITY ANALYSIS: Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained. LIMITATION: The benefit of sacubitril-valsartan is based on a single clinical trial. CONCLUSION: Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.
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