For heart failure patients with reduced ejection fraction (HFrEF), sacubitril/valsartan remained more cost-effective compared with enalapril, according to data published in JAMA Cardiology.
Thomas A. Gaziano, MD, MSc, of the Division of Cardiovascular Medicine at Brigham and Women’s Hospital, Boston, and colleagues conducted their study to estimate the cost-effectiveness of sacubitril/valsartan compared with enalapril in the United States.
Dr Gaziano and his colleagues used data from a cohort of US adults (mean age: 63.8 years) as inputs for a 2-state Markov model for simulated heart failure. All patients had HFrEF and characteristics similar to those in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial.
Researchers estimated risks of all-cause mortality and heart failure hospitalization with a 30-year time horizon, and calculated quality of life with trial EQ-5D scores. Hospital costs were calculated by combining Medicare and private insurance reimbursement rates, and medication costs were estimated with wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was also applied.
A sensitivity analysis was also conducted with key inputs that included hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality of life estimates. Overall, the researchers measured hospitalizations, quality-adjusted life-years, costs, and incremental costs per quality-adjusted life-years gained.
“Use of sacubitril/valsartan could lead to more than a year of life gained per patient using the medication and significant cost savings through avoided hospitalizations,” the authors noted. “Because of this additional life expectancy with 5.7 million individuals in the United States with HF, the benefits of expanded use of sacubitril/valsartan could be large.”
The 2-state Markov model found that there would be 220 fewer hospital admissions per 1000 heart failure patients treated with sacubitril/valsartan compared with enalapril over 30 years.
Incremental costs with sacubitril/valsartan were estimated at $35 512, and the quality-adjusted life-years gained was 0.78 compared with enalapril. This equated to an incremental cost-effectiveness ratio (ICER) of $45 017 per quality-adjusted life-year for the base-case. The sensitivity analyses revealed ICERs ranging from $35 357 to $75 301 per quality of life year.
“For every 100 000 people receiving sacubitril/valsartan, this strategy could potentially reduce hospitalization by 3000 and reduce deaths by nearly the same number over a 2-year period,” the authors concluded. “Medical savings from reduced HF admissions would be more than $27 million.”
Disclosures: Dr Gaziano received grant support from Brigham and Women’s Hospital from Novartis and Mr Chan and Ms Deschaseaux-Voinet were employees of Novartis. Dr Rouleau and Dr McMurray also received support from Novartis. Dr Solomon also received grant support and personal fees from Brigham and Women’s Hospital.
Gaziano TA, Fonarow GC, Claggett B, et al. Cost-effectiveness analysis of sacubitril/valsartan vs enalapril in patients with heart failure and reduced ejection fraction. JAMA Cardiol. 2016. doi: 10.1001/jamacardio.2016.1747.