Budget impact of adding ivabradine to standard of care in patients with chronic systolic heart failure in the United States

Borer, J. S. et al. (2016) Budget impact of adding ivabradine to standard of care in patients with chronic systolic heart failure in the United States. Journal of Managed Care and Specialty Pharmacy, 22(9), pp. 1064-1071. (doi: 10.18553/jmcp.2016.22.9.1064) (PMID:27574749)

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BACKGROUND: Heart failure (HF) costs $21 billion annually in direct health care costs, 80% of which is directly attributable to hospitalizations. The SHIFT clinical study demonstrated that ivabradine plus standard of care (SoC) reduced HF-related and all-cause hospitalizations compared with SoC alone. OBJECTIVE: To estimate the budget impact of ivabradine from a U.S. commercial payer perspective. METHODS: A budget impact model estimated the per-member-per month (PMPM) impact of introducing ivabradine to existing formularies by comparing a reference scenario (SoC) and a new drug scenario (ivabradine + SoC) in hypothetical 1 million-member commercial and Medicare Advantage plans. In both scenarios, U.S. claims data were used for the reference cumulative annual rates of hospitalizations (HF, non-HF cardiovascular [CV], and non-CV), and hospitalization rates were adjusted using SHIFT data. The model controlled for mortality risk using SHIFT and U.S. life table data, and hospitalization costs were obtained from U.S. claims data: HF-related = $37,507; non-HF CV = $28,951; and non-CV = $17,904. The annualized wholesale acquisition cost of ivabradine was $4,500, with baseline use for this new drug at 2%, increasing 2% per year. RESULTS: Based on the approved U.S. indication, approximately 2,000 commercially insured patients from a 1 million-member commercial plan were eligible to receive ivabradine. Ivabradine resulted in a PMPM cost savings of $0.01 and $0.04 in years 1 and 3 of the core model, respectively. After including the acquisition price for ivabradine, the model showed a decrease in total costs in the commercial ($991,256 and $474,499, respectively) and Medicare populations ($13,849,262 and $4,280,291, respectively) in year 1. This decrease was driven by ivabradine’s reduction in hospitalization rates. For the core model, the estimated pharmacy-only PMPM in year 1 was $0.01 for the commercial population and $0.24 for the Medicare Advantage population. CONCLUSIONS: Adding ivabradine to SoC led to lower average annual treatment costs. The negative PMPM budget impact indicates that ivabradine is an affordable option for U.S. payers.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Ford, Professor Ian
Authors: Borer, J. S., Kansal, A. R., Dorman, E. D., Krotneva, S., Zheng, Y., Patel, H. K., Tavazzi, L., Komajda, M., Ford, I., Böhm, M., and Kielhorn, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Journal of Managed Care and Specialty Pharmacy
Publisher:Academy of Managed Care Pharmacy
ISSN (Online):2376-1032
Copyright Holders:Copyright © 2016 Academy of Managed Care Pharmacy
First Published:First published in Journal of Managed Care and Specialty Pharmacy 22(9):1064-1071
Publisher Policy:Reproduced with the permission of the publisher.

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