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