Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction
BACKGROUND: Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction.
OBJECTIVE: To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure.
DESIGN: Markov decision model.
DATA SOURCES: Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables.
TARGET POPULATION: Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less.
TIME HORIZON: Lifetime.
PERSPECTIVE: Societal.
INTERVENTION: Treatment with sacubitril-valsartan or lisinopril.
OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios.
RESULTS OF BASE-CASE ANALYSIS: The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure.
RESULTS OF SENSITIVITY ANALYSIS: Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained.
LIMITATION: The benefit of sacubitril-valsartan is based on a single clinical trial.
CONCLUSION: Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure.
PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.
| Errataetall: |
CommentIn: Ann Intern Med. 2016 Nov 15;165(10 ):735-736. - PMID 27571568 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:165 |
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| Enthalten in: |
Annals of internal medicine - 165(2016), 10 vom: 15. Nov., Seite 681-689 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sandhu, Alexander T [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 27.04.2017 Date Revised 08.04.2022 published: Print-Electronic CommentIn: Ann Intern Med. 2016 Nov 15;165(10 ):735-736. - PMID 27571568 Citation Status MEDLINE |
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| doi: |
10.7326/M16-0057 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Ann Intern Med. 2016 Nov 15;165(10 ):735-736. - PMID 27571568 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction | ||
| 520 | |a OBJECTIVE: To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure | ||
| 520 | |a DESIGN: Markov decision model | ||
| 520 | |a DATA SOURCES: Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables | ||
| 520 | |a TARGET POPULATION: Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less | ||
| 520 | |a TIME HORIZON: Lifetime | ||
| 520 | |a PERSPECTIVE: Societal | ||
| 520 | |a INTERVENTION: Treatment with sacubitril-valsartan or lisinopril | ||
| 520 | |a OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios | ||
| 520 | |a RESULTS OF BASE-CASE ANALYSIS: The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure | ||
| 520 | |a RESULTS OF SENSITIVITY ANALYSIS: Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained | ||
| 520 | |a LIMITATION: The benefit of sacubitril-valsartan is based on a single clinical trial | ||
| 520 | |a CONCLUSION: Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure | ||
| 520 | |a PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review | ||
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