Cost-Effectiveness Of Sacubitril/Valsartan In The Treatment Of Heart Failure In Costa Rica

Abstract

gained) over a 30-year time horizon. Sensitivity analyses were performed. ReSultS: Base-case results suggest that compared to ACEi, sacubitril/valsartan is associated with incremental costs of ₡3,385,614 and 0.53 QALYs gained, with an incremental cost-effectiveness ratio of ₡6,400,593 per QALY gained. Increased costs of pharmacological therapy were offset by reductions in hospitalization costs. All-cause-and CV-related mortality estimates were reduced at all time points. Expected survival estimates increased from 5.84 years for those receiving an ACEi to 6.45 years for those receiving sacubitril/valsartan. Overall, results were not sensitive to changes in model parameters; results were most sensitive to CV mortality estimates and treatment-effect duration. ConCluSionS: The Costa Rica-adapted model estimates suggest that sacubitril/valsartan represents a cost-effective intervention in the treatment of HFrEF (NYHA Class II-IV) versus ACEi, assuming a willingness-topay threshold of 3 times per capita GDP in Costa Rica (₡25,807,290). Consequently, sacubitril/valsartan represents reasonable value compared with other commonly accepted health care interventions.

Model parameters influencing the cost-effectiveness of sacubitril/valsartan in heart failure: evidence from a systematic literature review

“…A study from Thailand concluded that sacubitril/valsartan may not be a cost-effective therapy in the base-case (ICER/QALY THB162,276; WTP THB160,000), and that risk of cardiovascular death in patients who received enalapril was the most influential model driver [36]. One-way SA indicated that the constant coefficient (Portugal [26], Singapore [40], Taiwan [31], Brazil [39], Costa Rica [38], and Colombia [41]) and agesquared coefficient (the Netherlands [43], Denmark [41]) in the Gompertz distribution of cardiovascular mortality were parameters that had the most influence on the CE results, but ICERs at the lower bound of the 95% CI remained below the WTP limits. In the CE models from Portugal (€36,059) [26], Denmark (Kr285,710) [41], Australia (A$71,404) [27], Sin- CV cardiovascular, ICER incremental cost-effectiveness ratio, TE treatment effect gapore (SG$1,447,103) [19], and Thailand (THB290,000) [36], the ICERs estimated at the upper bound of the 95% CI were above the country-specific thresholds.…”

“…CE models using a Markov structure with regression-based modeling generally considered hospitalizations, AEs, and health-related quality of life (HRQoL) within the “alive” health state. A model based on Markov structure using regression equations for outcomes was developed by McMurray et al for the UK [ 41 ] and was adapted for several countries, including Spain [ 37 ], Switzerland [ 25 ], Netherlands [ 43 ], Denmark [ 41 ], Sweden [ 28 ], Greece [ 47 ], Czech Republic [ 46 ], Portugal [ 26 ], Turkey [ 45 ], Singapore [ 40 ], Taiwan [ 31 ], South Korea [ 42 ], Brazil [ 39 ], Cost Rica [ 38 ], and Colombia [ 41 ]. A study from India by Gokhale et al adopted a cost-consequence analysis to predict HF hospitalizations and mortality with sacubitril/valsartan versus ACEi in patients with chronic HFrEF [ 54 ].…”

“…Most models used enalapril as the comparator, cost-utility analysis as the economic analysis type, payer’s perspective, lifetime horizon, and a monthly cycle. The discount rates on costs and health outcomes ranged from 1.5 [ 21 , 43 ] to 5% [ 38 , 39 , 41 , 42 , 48 ]. The model results were commonly reported as total costs, ICERs, life-years gained, QALYs gained, and willingness-to-pay (WTP) thresholds.…”

“…Fourteen CE analyses showed cardiovascular mortality as the key driver of the sacubitril/valsartan model (Table 1 ) [ 19 , 26 , 27 , 29 , 31 , 35 , 36 , 38 – 41 , 43 , 60 ]. A study from Thailand concluded that sacubitril/valsartan may not be a cost-effective therapy in the base-case (ICER/QALY THB162,276; WTP THB160,000), and that risk of cardiovascular death in patients who received enalapril was the most influential model driver [ 36 ].…”

“…Time horizon was explored in the SAs of 14 studies (Table 2 ) [ 17 , 19 , 25 , 29 , 38 , 42 , 43 , 49 , 50 , 52 , 55 , 56 , 59 , 62 ]. Three of the four model analyses [ 19 , 30 , 36 , 52 ] which concluded that sacubitril/valsartan is not a cost-effective therapy modeled shorter time horizons (5 [ 52 ], 10 [ 19 ], and 15 years [ 30 ]) than lifetime in the base-case analysis while other studies with a lifetime horizon typically reported sacubitril/valsartan as cost-effective.…”