Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction

McMurray, J. J.V. et al. (2018) Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction. Heart, 104(12), pp. 1006-1013. (doi: 10.1136/heartjnl-2016-310661) (PMID:29269379) (PMCID:PMC5992367)

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Objective: Chronic heart failure with reduced ejection fraction (HF-REF) represents a major public health issue and is associated with considerable morbidity and mortality. We evaluated the cost-effectiveness of sacubitril/valsartan (formerly LCZ696) compared with an ACE inhibitor (ACEI) (enalapril) in the treatment of HF-REF from the perspective of healthcare providers in the UK, Denmark and Colombia. Methods: A cost-utility analysis was performed based on data from a multinational, Phase III randomised controlled trial. A decision-analytic model was developed based on a series of regression models, which extrapolated health-related quality of life, hospitalisation rates and survival over a lifetime horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). Results: In the UK, the cost per quality-adjusted life-year (QALY) gained for sacubitril/valsartan (using cardiovascular mortality) was £17 100 (€20 400) versus enalapril. In Denmark, the ICER for sacubitril/valsartan was Kr 174 000 (€22 600). In Colombia, the ICER was COP$39.5 million (€11 200) per QALY gained. Deterministic sensitivity analysis showed that results were most sensitive to the extrapolation of mortality, duration of treatment effect and time horizon, but were robust to other structural changes, with most scenarios associated with ICERs below the willingness-to-pay threshold for all three country settings. Probabilistic sensitivity analysis suggested the probability that sacubitril/valsartan was cost-effective at conventional willingness-to-pay thresholds was 68%–94% in the UK, 84% in Denmark and 95% in Colombia. Conclusions: Our analysis suggests that, in all three countries, sacubitril/valsartan is likely to be cost-effective compared with an ACEI (the current standard of care) in patients with HF-REF.

Item Type:Articles
Additional Information:This analysis and the PARADIGM-HF study were funded by Novartis AG.
Keywords:Health care economics, heart failure with reduced ejection fraction, quality and outcomes of care.
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Briggs, Professor Andrew
Authors: McMurray, J. J.V., Trueman, D., Hancock, E., Cowie, M. R., Briggs, A., Taylor, M., Mumby-Croft, J., Woodcock, F., Lacey, M., Haroun, R., and Deschaseaux, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN (Online):1468-201X
Published Online:21 December 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Heart 104(12): 1006-1013
Publisher Policy:Reproduced under a Creative Commons License

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