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ABSTRACT
Objectives: This study assesses the cost-effectiveness of sacubitril/valsartan versus enalapril in patients with symptomatic heart failure with reduced ejection fraction (HFrEF).
Methods: We used a previously developed Markov model calibrated with patient-level data from the PARADIGM-HF trial, adapted to the Portuguese setting. The model considers two health states (alive or dead) and uses regression analyzes to estimate hospitalizations and deaths over time. A panel of experts estimated resource consumption in the outpatient setting. To estimate resource consumption with hospitalizations, the National Health Service Diagnosis Related Groups database was used. Unit costs were based on national legislation, and on the Infomed database. The model considers a societal perspective, a time horizon of 30-years, and a 5% annual discount rate. Sensitivity analyses assessed the robustness of results.
Results: Sacubitril/valsartan increases life expectancy by 0.5 life-years, corresponding to 0.4 incremental quality adjusted life-years (QALY) versus enalapril. The estimated incremental cost-effectiveness ratio (ICER) is 22,702€/QALY. Sensitivity analysis shows that results are robust, but sensitive to the parameter estimates of the cardiovascular survival curve.
Conclusion: Sacubitril/valsartan is a cost-effective therapeutic option in the treatment of Portuguese patients with HFrEF and translate into significant health gains and increased life expectancy versus the current standard of care.
Article Highlights
Heart failure is a major health problem worldwide, accounting for a significant social and economic burden.
Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor, is an innovative therapeutic option for the treatment of patients with symptomatic chronic heart failure with reduced ejection fraction.
Sacubitril/valsartan showed clinically relevant and statistically significant mortality and heart failure hospitalization reductions versus enalapril in this population.
This paper aims to assess the cost-effectiveness of sacubitril/valsartan compared with enalapril, both combined with standard therapy, for the treatment of patients with heart failure with reduced ejection fraction with New York Heart Association class II-IV in Portugal.
Sacubitril/valsartan is estimated to be associated with health gains and increased life expectancy versus the current standard of care, which is translated into a cost-effective therapy for the treatment of patients with chronic heart failure with reduced ejection fraction.
Declaration of interest
M Afonso-Silva and P A. Laires are employees of Novartis Farma, Produtos Farmacêuticos SA, Porto Salvo, Portugal. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer Disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contribution statement
M Gouveia and J Alarcão undertook the analysis of data and interpreted results. M Borges, R Ascenção and J Costa contributed to the interpretation of the results. M Afonso-Silva and P A. Laires contributed to the interpretation of the results and preparation of the manuscript. All authors read and approved the final manuscript.
Supplementary material
Supplemental data for this article can be accessed here