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

Abstract

Objectives To summarize cost-effectiveness (CE) evidence of sacubitril/valsartan for the treatment of heart failure (HF) patients with reduced ejection fraction (HFrEF). The impact of different modeling approaches and parameters on the CE results is also described. Methods We conducted a systematic literature review using multiple databases: Embase®; MEDLINE®; MEDLINE®-In Process; NIHR CRD database including DARE, NHS EED, and HTA databases; and the Cost Effectiveness Analysis registry. We also reviewed HTA countries’ websites to identify CE reports of sacubitril/valsartan, published up to 25-July-2021. Articles published in English as full-texts, conference-abstracts, or HTA reports were included. Results We included 44 CE models [39 from 37 publications (22 full-texts; 15 conference-abstracts) and 5 HTAs; Europe, n = 20; North and South Americas, n = 14; Asia and Australia, n = 10]. Most models adopted a Markov structure with constant transition probabilities of events (n = 27) or a mix of Markov and regression-based models (n = 16), with variations in structural assumptions and chosen parameters. Study authors concluded sacubitril/valsartan to be a cost-effective therapy in 37/41 models in chronic HFrEF patients and 2/3 models in hospitalized patients stabilized after an acute decompensation for HF. CE models showing sacubitril/valsartan not to be a cost-effective treatment generally modeled a shorter time horizon. Effect of sacubitril/valsartan on cardiovascular and all-cause mortality, cost, duration of effect and time horizon was the main model drivers. Conclusions Most evidence indicated sacubitril/valsartan is cost-effective in HFrEF. The use of a lifetime horizon is recommended in future models as HF is a chronic disease. Data on the CE of sacubitril/valsartan in the inpatient setting were limited and further research is warranted.

Estimating the clinical and budgetary impact of using angiotensin receptor neprilysin inhibitor as first line therapy in patients with HFrEF

“…In contrast, a restricted use of ARNI would imply substantial loss in population health benefits. These results are aligned with the findings of prior cost‐effectiveness analyses comparing ARNI against ACEi 25‐27 . Given the indicative cost‐effectiveness results, the impact of the increased use of ARNI in the first line is likely to be generalizable to other countries with similar health care systems, which should be explored in further research.…”

“…These results are aligned with the findings of prior cost‐effectiveness analyses comparing ARNI against ACEi. 25 , 26 , 27 Given the indicative cost‐effectiveness results, the impact of the increased use of ARNI in the first line is likely to be generalizable to other countries with similar health care systems, which should be explored in further research. These findings should be interpreted carefully, as this study is not a traditional cost‐effectiveness analysis that models one cohort of patients over a life‐time horizon.…”