Cost-effectiveness of Sacubitril-Valsartan in Hospitalized Patients Who Have Heart Failure With Reduced Ejection Fraction

Abstract

IMPORTANCE Sacubitril-valsartan use reduces mortality and hospitalizations compared with enalapril among patients with chronic heart failure with reduced ejection fraction (HFrEF); however, the cost-effectiveness of these treatments when initiated during hospitalization for HF is unknown.OBJECTIVE To estimate the cost-effectiveness of inpatient initiation of sacubitril-valsartan vs enalapril compared with no initiation or posthospitalization initiation of sacubitril-valsartan among stabilized patients with HFrEF. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation included data on US patients with HFrEF who were eligible for sacubitril-valsartan treatment from December 8, 2009, to May 15, 2018. MAIN OUTCOMES AND MEASURESA 5-state Markov model with all-cause mortality, HF, and non-HF hospitalization probabilities was used. Quality of life was estimated using Euro-QoL EQ-5D scores. Hospitalization, long-term care, and medication costs for sacubitril-valsartan and enalapril were modeled with a discount rate of 3%. The base-case analysis included a lifetime horizon from a health care and societal perspective.RESULTS Modeled patients were a mean (SD) age of 63.8 (11.5) years. Inpatient treatment with sacubitril-valsartan ($5628 per year) was associated with 62 fewer HF-related admissions per 1000 patients compared with outpatient initiation or 116 fewer HF-related admissions compared with continuation of enalapril treatment. From a health care system perspective, initiation of sacubitril-valsartan during hospitalization saved $452 per year compared with continuing enalapril and $811 per year compared with initiation at 2 months after hospitalization and was associated with an incremental cost-effectiveness ratio of $21 532 per quality-adjusted life-year compared with continued enalapril treatment over a lifetime. From a societal perspective, inpatient initiation was estimated to save $460 per year per patient compared with no initiation of sacubitril-valsartan and $813 per year per patient compared with initiation after hospitalization. In a budget analysis, inpatient initiation of sacubitril-valsartan was estimated to save up to $449 per person for 1 year or $2550 per person over 5 years compared with continuation of enalapril. CONCLUSIONS AND RELEVANCEThe findings suggest that, for patients with HFrEF, initiation of sacubitril-valsartan during hospitalization may be associated with reduced hospitalizations, increased quality-adjusted life expectancy, and cost savings compared with no initiation or initiation after hospitalization.

Cost Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective

“…The lifetime estimates of life expectancy, QALYs, and costs for PSoCT alone from our analysis were slightly lower than those reported in previous US cost-effectiveness analyses for patients with HFrEF [22,28,39,40] (Supplementary Table 3 in the ESM). For example, our estimate of discounted life expectancy of 3.82 years for PSoCT was slightly lower than previous estimates (6.04-8.40 years over a lifetime horizon) [22,28,39,44], while our estimate of 3.05 discounted QALYs for PSoCT was also lower than that in the literature (4.53-6.02 QALYs over a lifetime horizon) [22,28,39,40,44]. Such differences were likely due to the fact that the VICTORIA population had recently experienced a WHFE [9] and therefore had worse prognoses and clinical outcomes.…”

“…Vericiguat was associated with a more favorable treatment effect in patients with a lower baseline NT-proBNP compared with patients who had a higher baseline NT-proBNP level [9]. The lifetime estimates of life expectancy, QALYs, and costs for PSoCT alone from our analysis were slightly lower than those reported in previous US cost-effectiveness analyses for patients with HFrEF [22,28,39,40] (Supplementary Table 3 in the ESM). For example, our estimate of discounted life expectancy of 3.82 years for PSoCT was slightly lower than previous estimates (6.04-8.40 years over a lifetime horizon) [22,28,39,44], while our estimate of 3.05 discounted QALYs for PSoCT was also lower than that in the literature (4.53-6.02 QALYs over a lifetime horizon) [22,28,39,40,44].…”

“…Prior studies in HFrEF-both clinical and observational-included relatively heathier HFrEF populations and therefore cannot be used for the validation of our model results. In addition, the predicted life expectancy was validated against previous US cost-effectiveness analyses for patients with HFrEF [22,28,39,40].…”

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients

“…Current literature also suggests early initiation of the ARNI (50 mg BID) as an effective, risk-free, therapeutic approach that increases quality-adjusted life expectancy and cost savings compared with no initiation or initiation late after hospitalization [ 33 , 34 ].…”

Angiotensin receptor-neprilysin inhibition in patients with acute decompensated heart failure: an expert consensus position paper

“…From a healthcare system perspective, initiation of sac/val during hospitalization saves $452 per year as compared with continuing enalapril and $811 per year as compared with a strategy of late post-discharge initiation [38]. Moreover, initiation of sac/val as an inpatient was associated with an incremental cost-effectiveness ratio of $21,532 per qualityadjusted life-year as compared with continued enalapril treatment over a lifetime [38].…”