Cost-effectiveness of switching patients with heart failure and reduced ejection fraction to sacubitril/valsartan: The Australian perspective

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Abstract

Background: The cost-effectiveness, from the Australian healthcare perspective, of switching patients with heart failure and reduced ejection fraction (HFREF) stable on angiotensin converting enzyme (ACE) inhibitors [3TD$DIF]/angiotensin II receptor blockers (ARBs) to sacubitril/valsartan is unclear. We sought to assess the cost-effectiveness of sacubitril/valsartan versus enalaprilin patients with HFREF in the contemporary Australian setting. Methods: We developed a Markov model with two health states (‘Alive’ and ‘Dead’) to assess the cost-effectiveness of sacubitril/valsartan versus enalaprilin patients with HFREF. Model subjects were 63 years of age at entry and had simulated follow-up over 20 years. Transition probabilities were derived from the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) study. Costs and utility data were derived from published sources. All costs and effects were discounted at an annual rate of 5% and are presented in Australian dollars. Sensitivity analyses were undertaken to test variability in key data inputs. Results: In the base-case analysis, sacubitril/valsartan was found to reduce non-fatal heart failure hospitalisations and cardiovascular deaths, with numbers-needed-to-treat over a 20-year period of 40 and 27, respectively. The use of sacubitril/valsartan led to an additional 6 months of life gained per patient, translating to A$27,954 per years of life saved (YoLS) and A$40,513 per quality-adjusted-life-years (QALY) gained. The results of the sensitivity analyses indicated that the results were robust. Conclusions: Our analysis supports switching HFREF patients on ACE inhibitor or ARB to sacubitril/valsartan.
Original languageEnglish
Number of pages8
JournalHeart Lung and Circulation
DOIs
Publication statusAccepted/In press - Aug 2019

Keywords

  • Heart failure
  • Cost-effectiveness
  • Sacubitril-valsartan
  • Enalapril

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