1. Patients treated with sacubitril-valsartan experienced reduction in cardiovascular morbidity and mortality.
2. Cost effectiveness of sacubitril-valsartan was sensitive to the duration of improved outcomes.
Evidence Rating Level: 2 (Good)
Study Rundown: Sacubitril-valsartan (Entresto, by Novartis) is a novel medication found to treat heart failure with reduced ejection fraction. Following a randomized, double blind trial, known as PARADIGM-HF, sacubitril-valsartan was shown to reduce cardiovascular mortality, decrease hospitalizations, and improve quality of life, compared with the current standard of practice (lisinopril). Despite these benefits, sacubitril-valsartan is substantially more expensive than lisinopril. The authors of this study, therefore, assessed the cost-effectiveness of sacubitril-valsartan compared to usual care in a cohort of patients with New York Heart Association (NYHA) class II to IV heart failure. Specifically, they determined a cost of $47 053 per quality-adjusted life years (QALYs) gained when treating patients with sacubitril-valsartan. There were several limitations to this study. First, efficacy of sacubitril-valsartan treatment was determined from a single trial. Additionally, no data was available regarding long-term treatment efficacy. Overall, the analyses suggested that sacubitril-valsartan is a cost-effective treatment for patients with New York Heart Association (NYHA) class II to IV heart failure and reduced ejection fraction.
In-Depth [prospective cohort]: The authors of this study assessed cost-effectiveness of sacubitril-valsartan through a Markov decision model. Specifically, they modelled a cohort of patients from the PARADIGM-HF trial and compared outcomes in terms of cost, life-years, QALYs, and heart failure hospitalizations between two treatment groups: lisinopril and sacubitril-valsartan therapy. Following the analyses, it was determined that for NYHA class II-IV heart failure patients, treatment with sacubitril-valsartan resulted in 0.08 fewer heart failure hospitalizations, 0.69 increased survival years, and 0.62 increased QALYs. Furthermore, the cost of sacubitril-valsartan per life year for NYHA class II-IV patients was $42 397. The authors found that the improved outcomes of sacubitril-valsartan treatment would need to be sustained for at least 36 months in order to keep cost per QALY lower than $100 000.
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