Cost-Effectiveness of Therapies for Heart Failure in Brazil: A Systematic Review

Heart failure (HF) is among the leading causes of cardiovascular mortality in Brazil. In 2021, costs attributable to HF exceeded R$ 22 billion in the Brazilian Unified Health System (SUS). The incorporation of new therapeutic technologies increases the need for cost-effectiveness analyses. To perform a systematic review of economic analyses related to pharmacological and nonpharmacological therapies for HF in Brazil. Searches was conducted in the PubMed, Embase, LILACS, and SciELO databases. Brazilian studies that evaluated costs and cost-effectiveness of therapies in HF were included. The analyzed outcomes were disease cost, cost per quality-adjusted life years (QALY), and cost per clinical outcome. A total of 25 studies were included. Cost-effectiveness analyses used willingness-to-pay thresholds derived from gross domestic product per capita, according to recommendations of the National Committee for Health Technology Incorporation in the Brazilian Unified Health System. From the SUS perspective, in patients with HF with reduced ejection fraction, spironolactone and eplerenone were cost-effective, with incremental cost-effectiveness ratios (ICER) in international dollars (Int$) of 7,955/QALY and Int$ 6,459/QALY, respectively. Dapagliflozin and sacubitril-valsartan showed ICERs of Int$ 9,000/QALY and Int$ 11,691/QALY, respectively, and were also considered cost-effective. Cardiac resynchronization therapy was classified as highly cost-effective (ICER Int$ 15,723/QALY), whereas the implantable cardioverter-defibrillator for primary prevention did not demonstrate cost-effectiveness (ICER Int$ 50,345/QALY). Several HF interventions show economic attractiveness. However, most technologies were evaluated in only one study, which limits more robust analyses. Expanding national economic studies is necessary to support access to effective therapies while maintaining the sustainability of the health system.