Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction

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Alexander T Sandhu1, Daniel A Ollendorf1, Richard H Chapman1

  • 1From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, and Stanford University School of Medicine, Stanford, California; and Institute for Clinical and Economic Review, Boston, Massachusetts.

Annals of Internal Medicine
|August 30, 2016
PubMed

Insights

Sacubitril-valsartan therapy offers reasonable value for managing heart failure with reduced ejection fraction, reducing hospitalizations and improving life-years gained. This treatment provides significant benefits for patients with NYHA class II to IV heart failure.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Pharmacoeconomics

Background:

  • Sacubitril-valsartan therapy demonstrably reduces cardiovascular mortality in patients with heart failure with reduced ejection fraction compared to enalapril.
  • Chronic heart failure (HF) management remains a significant clinical and economic challenge.

Purpose of the Study:

  • To conduct a cost-effectiveness analysis of sacubitril-valsartan compared to angiotensin-converting enzyme inhibitor (ACEI) therapy for patients with chronic heart failure.
  • Evaluate the long-term value of sacubitril-valsartan in a real-world or simulated patient population.

Main Methods:

  • A Markov decision model was employed to simulate patient outcomes over a lifetime horizon.
  • Data sources included clinical trials, observational studies, Medicare reimbursement data, drug pricing, and mortality tables.
  • The target population comprised patients aged 64 years with New York Heart Association (NYHA) class II-IV heart failure and ejection fraction ≤0.40.

Main Results:

  • Sacubitril-valsartan resulted in 0.62 additional quality-adjusted life-years (QALYs) and 0.69 additional life-years at an incremental cost of $29,203, yielding a cost per QALY of $47,053.
  • Cost-effectiveness varied by NYHA class: $44,531/QALY for class II and $58,194/QALY for class III/IV.
  • Sensitivity analysis indicated treatment duration was the most influential factor, with a cost per QALY of $120,623 if benefits were limited to the trial duration (27 months).

Conclusions:

  • Sacubitril-valsartan therapy represents a reasonable value for improving cardiovascular outcomes in patients with NYHA class II-IV heart failure.
  • The study's findings are based on data from a single clinical trial, highlighting a key limitation.
  • Further research may be needed to confirm long-term benefits and cost-effectiveness across diverse patient populations.
Abstract

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