Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction

• Published in: JACC. Heart failure Vol. 4; no. 5; pp. 392 - 402
• Main Authors: King, Jordan B., PharmD, Shah, Rashmee U., MD, MS, Bress, Adam P., PharmD, MS, Nelson, Richard E., PhD, Bellows, Brandon K., PharmD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016
• Subjects: Aged; Aged, 80 and over; Aminobutyrates - economics; Aminobutyrates - therapeutic use; angiotensin inhibition; Angiotensin Receptor Antagonists - economics; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - economics; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Cardiovascular; Cardiovascular Diseases - mortality; Cost-Benefit Analysis; cost utility; Drug Combinations; Enalapril - economics; Enalapril - therapeutic use; Female; Heart Failure - drug therapy; Heart Failure - physiopathology; Hospitalization; Humans; LCZ696; Male; Markov Chains; Middle Aged; Neprilysin - antagonists & inhibitors; neprilysin inhibition; Quality-Adjusted Life Years; Stroke Volume; Tetrazoles - economics; Tetrazoles - therapeutic use; BB; NYHA; heart failure; willingness to pay; angiotensin inhibition; beta-blocker; angiotensin receptor neprilysin inhibition; ICER; HFrEF; ARB; heart failure with a reduced ejection fraction; New York Heart Association; ARNI; WTP; neprilysin inhibition; angiotensin converting enzyme inhibitor; angiotensin II receptor blocker; ACEI; incremental cost-effectiveness ratio; LCZ696; cost utility; HF; cost utility
• ISSN: 2213-1779; 2213-1787
• DOI: 10.1016/j.jchf.2016.02.007

Abstract Objectives The objective of this study was to determine the cost-effectiveness and cost per quality-adjusted life year (QALY) gained of sacubitril-valsartan relative to enalapril for treatment of heart failure with reduced ejection fraction (HFrEF). Background Compared with enalapril, combination angiotensin receptor–neprilysin inhibition (ARNI), as is found in sacubitril-valsartan, reduces cardiovascular death and heart failure hospitalization rates in patients with HFrEF. Methods Using a Markov model, costs, effects, and cost-effectiveness were estimated for sacubitril-valsartan and enalapril therapies for the treatment of HFrEF. Patients were 60 years of age at model entry and were modeled over a lifetime (40 years) from a third-party payer perspective. Clinical probabilities were derived predominantly from PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). All costs and effects were discounted at a 3% rate annually and are presented in 2015 U.S. dollars. Results In the base case, sacubitril-valsartan, compared with enalapril, was more costly ($60,391 vs $21,758) and more effective (6.49 vs 5.74 QALYs) over a lifetime. The cost-effectiveness of sacubitril-valsartan was highly dependent on duration of treatment, ranging from $249,411 per QALY at 3 years to $50,959 per QALY gained over a lifetime. Conclusions Sacubitril-valsartan may be a cost-effective treatment option depending on the willingness-to-pay threshold. Future investigations should incorporate real-world evidence with sacubitril-valsartan to further inform decision making.