Lower Hospitalization and Healthcare Costs With Sacubitril/Valsartan Versus Angiotensin‐Converting Enzyme Inhibitor or Angiotensin‐Receptor Blocker in a Retrospective Analysis of Patients With Heart Failure

Abstract

Background Outcomes data among patients with heart failure (HF) with reduced ejection fraction treated with sacubitril/valsartan ( SAC / VAL ) are largely limited to clinical trial results. We compared hospitalization and healthcare costs among real‐world patients with HF with reduced ejection fraction treated with SAC / VAL versus angiotensin‐converting enzyme inhibitor or angiotensin‐receptor blocker ( ACEI / ARB ). Methods and Results Using retrospective administrative claims data, stable patients with HF with reduced ejection fraction treated with SAC / VAL or ACEI / ARB from October 2015 to June 2016 were identified. Postindex hospitalization and healthcare costs were assessed in propensity‐matched cohorts using robust variance estimation. Time to first hospitalization was modeled using unadjusted Kaplan–Meier estimates and multivariable models. Postindex all‐cause healthcare costs were modeled using an adjusted multivariable model. Among 279 patients per matched cohort, postindex hospitalization risk was lower for SAC / VAL compared with ACEI / ARB using Kaplan–Meier estimation and unadjusted Cox models. For HF hospitalization, the hazard ratio (95% CI) was 0.56 (0.33–0.94; P =0.030). Adjusted results were similar to unadjusted. Mean ( SD ) monthly healthcare costs were lower for SAC / VAL versus ACEI / ARB for all categories except pharmacy, with hospital costs being particularly disparate between cohorts: for HF hospitalization, $248 ($1588) for SAC / VAL versus $1122 ($7290) for ACEI / ARB . The adjusted risk of incurring increased all‐cause postindex costs was lower for SAC / VAL versus ACEI / ARB (cost ratio [95% CI] 0.74 [0.59–0.94]; P =0.013). Conclusions In clinical practice, patients with HF with reduced ejection fraction treated with SAC / VAL were less likely to be hospitalized than matched patients treated with ACEI / ARB . Despite higher pharmacy costs, SAC / VAL –treated patients incurred lower monthly medical and total healthcare costs. ...

A global perspective on the costs of hypertension: a systematic review

“…In the USA, drug costs per QALY are as follows: angiotensin-converting-enzyme inhibitors – 34,244 USD, calcium channel blockers – 13,016 USD, β-blockers – from 1,498 to 18,137 USD (Park 2017) [ 62 ]. In the USA, drug costs per hospitalized person treated with sacubitril/valsartan amount to 248 USD, while costs per hospitalized person treated with angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers amount to 1,122 USD (Albert 2019) [ 63 ]. Thus, the sacubitril/valsartan treatment seems the most cost-effective pharmacological treatment.…”

A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020)

“…Three studies adopted a healthcare sector perspective [ 87 – 89 ]. Only two studies adopted the societal perspective [ 25 , 59 ], one study adopted the viewpoint of the patient [ 43 ], and one the hospital perspective [ 45 ]. The remaining 40 studies (only published as abstracts) left the perspective undefined entirely.…”

“…Forty-three studies identified from the SLR included a cost year and could be inflated to 2019 US$. Two of these, however, were excluded from the summary of comparable cost estimates because one study reported only informal caregiving costs [ 59 ], while in the other study, patients were identified by the index event of a pharmacy claim rather than an HF event [ 43 ]. The 41 remaining studies included in the summary of comparable cost estimates, along with the study-specific cost/price years and the original values are detailed in ESM 5.…”

“…Sources of resource use and unit costs, currency and cost year, and the methods of resource use valuation (i.e., cost/charge, cost-to-charge ratio) were well defined in all studies. The majority of studies (26/43; 60%) reported adequately on the methodology of estimating costs [ 22 – 24 , 43 , 44 , 49 , 50 , 57 – 60 , 63 , 66 – 72 , 75 – 77 , 85 , 87 , 88 , 116 ]; in 14 (33%), the costing approach was concluded by the information reported and relevant guidelines by Drummond et al [ 91 ], although not explicitly stated [ 25 , 45 – 47 , 53 – 55 , 64 , 65 , 81 , 86 , 89 , 90 , 118 ]; three studies (10%), only published as abstracts, did not provide any information on the costing methodology [ 34 , 73 , 97 ].…”

“…Another gap identified during this review was the paucity of data from perspectives other than the payer and the healthcare sector. Only four of the total 87 studies provided societal, patient, or hospital cost perspectives of HF events [ 25 , 43 , 45 , 59 ]. Social care costs are an important element of longer term care for patients with debilitating events.…”