Sacubitril/valsartan cost-effective for HFREF patients

Switching to sacubitril/valsartan is a cost-effective treatment option for patients with heart failure with reduced ejection fraction (HFREF), a recent Australia study has found.

The researchers constructed a decision analytic transition Markov model that compared the health effects and economic requirements of using sacubitril/valsartan (200 mg twice daily) vs enalapril (10 mg twice daily), a common reference standard. The model had yearly cycles and its population included 1,000 HFREF patients, assumed to be 63 years of age at entry.

The model had two health states (alive with HFREF and dead), and four transition states, which could occur in any order: “no HF hospitalization, stay alive,” “nonfatal hospitalization for HF,” “CV death,” and “non-CV death.” Over a time horizon of 20 years, the model assessed the incremental cost-effectiveness ratio (ICER), in Australian dollars, per years of life saved (YoLS) and per quality-adjusted life-years (QALY) gained.

Most of the participants died by the end of the 20-year projection, with <5 percent left surviving. Patients in the sacubitril/valsartan group were modelled to live an average of 5.36 years and 3.70 QALYs, while the corresponding values for the enalapril group were 4.92 years and 3.39 QALYs.

The sacubitril/valsartan patients incurred total treatment and disease-related costs of A$14,128,566 and A$6,150,973, respectively, totalling A$ 20,279,538. In comparison, the costs in the enalapril group were A$1,741,735, A$6,334,631, and A$8,076,366, respectively.

The resulting ICERs were A$27,954 per YoLS and A$40,513 per QALY gained, which “is comparable to other guideline-directed medical therapies in HF,” the researchers said.