Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction

Abstract

ObjectiveChronic heart failure with reduced ejection fraction (HF-REF) represents a major public health issue and is associated with considerable morbidity and mortality. We evaluated the cost-effectiveness of sacubitril/valsartan (formerly LCZ696) compared with an ACE inhibitor (ACEI) (enalapril) in the treatment of HF-REF from the perspective of healthcare providers in the UK, Denmark and Colombia.MethodsA cost-utility analysis was performed based on data from a multinational, Phase III randomised controlled trial. A decision-analytic model was developed based on a series of regression models, which extrapolated health-related quality of life, hospitalisation rates and survival over a lifetime horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER).ResultsIn the UK, the cost per quality-adjusted life-year (QALY) gained for sacubitril/valsartan (using cardiovascular mortality) was £17 100 (€20 400) versus enalapril. In Denmark, the ICER for sacubitril/valsartan was Kr 174 000 (€22 600). In Colombia, the ICER was COP$39.5 million (€11 200) per QALY gained. Deterministic sensitivity analysis showed that results were most sensitive to the extrapolation of mortality, duration of treatment effect and time horizon, but were robust to other structural changes, with most scenarios associated with ICERs below the willingness-to-pay threshold for all three country settings. Probabilistic sensitivity analysis suggested the probability that sacubitril/valsartan was cost-effective at conventional willingness-to-pay thresholds was 68%–94% in the UK, 84% in Denmark and 95% in Colombia.ConclusionsOur analysis suggests that, in all three countries, sacubitril/valsartan is likely to be cost-effective compared with an ACEI (the current standard of care) in patients with HF-REF.

Cost-Effectiveness of Sacubitril/Valsartan in Germany: An Application of the Efficiency Frontier

“…Compared to previously-published ICERs for European countries, which range from €17,600 to €23,401 with an average of €20,676, our ICER for Germany is within this range. [20][21][22][23][24][25] For Germany, Gandjour and Ostwald calculated an ICER of €23,401, a small difference when regarding their very different model design: the included discounts on sacubitril/valsartan, their inclusion of indirect medical costs and their adjustments to the PARADIGM-HF mortality rates, based on Germany-specific data. 25 This analysis has a number of limitations, first of all, for the inclusion of candesartan and placebo, we focused on the model parameters with the largest impact on the results: mortality and hospitalizations, as data on the other inputs were not available in scientific literature.…”

“…If the ICER would instead be used to assess the cost-effectiveness of sacubitril/valsartan in the German context, it would most likely be deemed cost-effective at market entry, as reported for other European countries. [20][21][22][23][24] This comparison marks a major difference in conclusions decision makers would draw using either the ICER or EF approach. If we consider a fixed budget for CHF alone, the EF may provide more relevant information for decision makers: the health gains per euro will not decrease as long as the treatment is on or above the frontier.…”

“…19 Subsequent to the approval of sacubitril/valsartan by the EMA, pharmacoeconomic evaluations have been published for many other European countries. [20][21][22][23][24] In a previous study from the Dutch perspective, we concluded that sacubitril/valsartan was cost-effective. 20 To date, one analysis for Germany has been published, reporting an ICER of €23,401 per life-year gained.…”

Angiotensin receptor-neprilysin inhibitors: A new paradigm in heart failure with reduced ejection fraction

“…A variety of economic analyses in a variety of health-care systems have been reported, with sacubitril/valsartan representing a costeffective option compared to enalapril at reducing morbidity and mortality, along with improving quality of life in patients with HFrEF. [52,53] Optimal implementation of sacubitril/valsartan in the United States of America (USA) has been projected to prevent over 28 000 deaths per year. [54] Despite this, there has been significant inertia with the uptake of sacubitril/valsartan into clinical practice; in the 18 months following FDA approval, <3% of patients in a USA cohort with HFrEF were prescribed sacubitril/valsartan.…”

Sacubitril-Valsartan Compared With Enalapril for the Treatment of Heart Failure: A Decision-Analytic Markov Model Simulation in China

“…ACE inhibitors (ACEIs) are typically the first-line treatment for HFrEF over the past few decades. Despite that ACEIs reduce the risk of hospitalization and death, the rates of hospitalization and death remain high as well as the loss of quality of life in HF patients (McMurray et al, 2018). The combination of the neprilysin inhibitor sacubitril and angiotensin-II receptor blocker (ARB) valsartan (Sac-Val) was proposed as a promising alternative for treating HFrEF in the last decade.…”