Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction

Lin, Liang; Wu, David Bin-Chia; Aziz, Mohamed Ismail Abdul; Wong, Raymond; Sim, David; Leong, Kui Toh Gerard; Wei, Yong; Tan, Doreen Su‐Yin

doi:10.1080/13696998.2017.1387119

Cited by 28 publications

(54 citation statements)

References 19 publications

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“…In this analysis, the ICER displayed sensitivity to the risk and probability of CV death but was barely affected by the risk of hospitalization. This is consistent with some cost-effectiveness analyses of Sac-Val reported previously (King et al, 2016;Liang et al, 2018;Zueger et al, 2018). Given that HF is a chronic disease with significant mortality, especially in the elderly patients, the modeled population would decline significantly over the projected period due to increasing deaths.…”

Section: Discussionsupporting

confidence: 86%

“…Owing to the high WTP threshold, Sac-Val is cost-effective in countries like United States (Gaziano et al, 2016;King et al, 2016;Sandhu et al, 2016), Netherlands (van der Pol et al, 2017), United Kingdom (McMurray et al, 2018 and other European countries (Zanfina et al, 2017;Gandjour and Ostwald, 2018;McMurray et al, 2018;van der Pol et al, 2019), even with high estimated ICERs. In contrast, opposite conclusions were drawn in similar studies conducted in Singapore (Liang et al, 2018) and Thailand (Krittayaphong and Permsuwan, 2018). With a 225-fold higher cost to that of enalapril, Sac-Val was not cost-effective compared to ACEIs in Thailand.…”

Section: Discussionmentioning

confidence: 69%

“…The baseline probabilities of hospitalization and CV death were derived from the Kaplan-Meier curves of enalapril group. Weibull and Exponential distribution were fitted to obtain the individual monthly transition probabilities (Liang et al, 2018). The clinical benefits of Sac-Val were modeled by applying the hazard ratios (HRs) to the baseline probabilities, and the NYHA class-specific probabilities for hospitalization and CV deaths were obtained by applying the hazard ratios (HRs) and relative risks (RRs) to the baseline probabilities.…”

Section: Date and Sourcesmentioning

confidence: 99%

“…Apart from the therapeutic effects, the results from PARADIGM-HF have also been used for evaluating the economic viability of Sac-Val ( Liu et al, 2020 ), especially in the developed countries ( Gaziano et al, 2016 ; King et al, 2016 ; Sandhu et al, 2016 ; van der Pol et al, 2017 ; Zanfina et al, 2017 ; Gandjour and Ostwald, 2018 ; Krittayaphong and Permsuwan, 2018 ; Liang et al, 2018 ; Zueger et al, 2018 ; Park et al, 2019 ; van der Pol et al, 2019 ). Owing to the high willingness-to-pay (WTP) threshold, Sac-Val is likely to be cost-effective compared to enalapril in United States ( Gaziano et al, 2016 ; King et al, 2016 ; Sandhu et al, 2016 ), United Kingdom ( McMurray et al, 2018 ) and some other European countries ( Zanfina et al, 2017 ; Gandjour and Ostwald, 2018 ; McMurray et al, 2018 ; van der Pol et al, 2019 ) despite the higher acquisition cost.…”

Section: Introductionmentioning

confidence: 99%

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

Tian

Peipei

et al. 2020

Front. Pharmacol.

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Objectives: Heart failure with reduced ejection fraction (HFrEF) is a major health concern globally due to high mortality rates, frequent hospitalization and considerable medical expenditure. The prevalence of HFrEF is steadily rising in Asian countries, and populous, developing countries like China are facing a significant socioeconomic burden as a result. Sacubitril-valsartan (Sac-Val) is currently a class I recommendation for treating HFrEF in major guidelines, although it has not been pharmaco-economically evaluated in China. To this end, we compared the cost-effectiveness of Sac-Val and enalapril based on the negotiated prices in order to fully assess the expected costs and benefits of the clinical use of Sac-Val in China. Method: A Markov model was constructed to estimate long-term clinical and economic outcomes of Sac-Val versus enalapril for HFrEF patients in China over a 10-year horizon. Primary model outcomes were total costs and quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results: Treatment with Sac-Val resulted in 4.67 QALYs at the cost of $4,684.25, while enalapril yielded 4.40 QALYs at the cost of $4,014.47. Compared to enalapril, Sac-Val was associated with a gain of 0.27 QALYs, resulting in an ICER of $ 2,480.67 per QALY. Deterministic sensitivity analysis showed robust results. Probabilistic sensitivity analysis suggested that Sac-Val has a 99.99% probability of being cost-effective at the willingnessto-pay threshold of $10,276. Conclusion: From Chinese patients' perspective, Sac-Val is a cost-effective treatment option for HFrEF in China compared to enalapril. Our findings can aid clinicians plan the Sac-Val regimen, as well as decision makers to discuss the value and position of novel angiotensin receptor neprilysin inhibitors (ARNIs) in future.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 69%

Section: Date and Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Tian

Peipei

et al. 2020

Front. Pharmacol.

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“…Similar issues were addressed in an Asian study conducted in Singapore. The findings reveled that at current daily price of $ 6.49 SAC/VAL may not be cost-effective compared to enalapril in reducing cardiovascular morbidity and mortality in HF in Singapore healthcare setting [30].…”

Section: Cost Effectiveness Of Sacubitril/valsartanmentioning

confidence: 98%

Sacubitril/Valsartan in Management of Heart Failure: A Review of Safety, Efficacy and Cost-Effectiveness

Ellahham¹

2018

Cardiovasc Pharm Open Access

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Heart failure (HF) is a leading cause of mortality and morbidity across the globe. High prevalence, frequent hospitalization, longterm healthcare, absenteeism from work, and death upsurge the economic burden of the HF. For almost two decades, the angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and beta-blockers (BBs) have remained the standard care of management for HF. But despite being efficacious and cost-effective theses standard treatment were unable reduce events of rehospitalization and improve quality of life for patients with HF. Recent innovative discovery of angiotensin receptor/neprilysin inhibitor (ARNI) therapy changed the entire outlook for management of HF. Sacubitril/Valsartan an ARNI proved out to be a revolutionary drug for patients of HF. Compared to other drug classes, Sacubitril/Valsartan combination therapy is more efficacious, have lesser adverse effect, and improves overall quality of life of HF patients with reduced ejection fraction. However, the cost-effectiveness of Sacubitril/Valsartan remained questionable in developing parts of world. At the current pricing Sacubitril/Valsartan was found to be cost-effective only at specific threshold of willingness to pay of the patients. Better Federal healthcare policies, new-pricing strategies, robust long-term real-world estimates of this drug are required to improve the cost-effective profile of this drug.

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Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

Yao

Zhang

et al. 2020

ESC Heart Failure

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Aims This study was to determine the cost-effectiveness of dapagliflozin in heart failure with reduced ejection fraction (HFrEF) patients in China from a perspective of health care payers. Methods and results We built a Markov model to perform a cost-effectiveness analysis comparing standard treatment + dapagliflozin (10 mg, q.d.) with standard treatment for HFrEF. The base case in our simulation was a 65-yearold HFrEF patient and was modelled over 15 years. Inputs of the model were derived from the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial and other relevant data from China. Costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) were estimated for adding dapagliflozin relative to standard treatment. Costs and QALY were discounted at a 4.2% rate annually. All costs are presented in 2017 US dollars. Dapagliflozin would be considered very cost-effective if the ICER was lower than a willingness-to-pay (WTP) threshold of $8573.4. Uncertainty was assessed in our model using one-way, two-way, and probabilistic sensitivity analysis (PSA). In our base case, compared with standard treatment, adding dapagliflozin was more expensive ($5829.4 vs. $4377.1) but more effective (4.82 vs. 4.44 QALYs). The respondent ICER was $3827.6 per QALY gained at 15-year follow-up. When the simulated horizon was longer than 3.5 years, the respondent ICER became lower than the WTP threshold. The inputs with the largest impact on ICER were the cost of dapagliflozin, the cardiovascular mortality in both groups, and the cost of hospitalization for heart failure. Most results of sensitivity analysis were robust. PSA showed a similar result as the base case (ICER = $4412.5 per QALY gained). In Monte Carlo simulation, at a WTP threshold of $8573.4 per QALY, dapagliflozin was considered very cost-effective in 53.10% of the simulations. Conclusions Dapagliflozin was a very cost-effective treatment option for HFrEF patients in China according to the result of our model. Our findings will help doctors and health care payers to make decisions in clinical practice. Future real-world studies of cost-effectiveness of dapagliflozin based on Chinese population were also needed.

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Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction

Cited by 28 publications

References 19 publications

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

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

Sacubitril/Valsartan in Management of Heart Failure: A Review of Safety, Efficacy and Cost-Effectiveness

Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

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