Sacubitril-valsartan may be a cost-effective treatment for NYHA class II-IV heart failure patients

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.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With 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.

Image: PD

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