ObjectiveChronic 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.MethodsA 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).ResultsIn 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.ConclusionsOur 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.

The treatment of HFrEF patients with sacubitril/valsartan versus enalapril is cost effective, if a willingness-to-pay threshold of CHF 50 000 per QALY gained ratio is assumed.

Objectives: Heart failure (HF) has a prevalence of 915.000 people in Italy and it is one of the main public health problems, with poor survival rates, high disability, significant economic burden and reduction in quality of life. A new treatment, sacubitril/valsartan, reduced CV death and HF hospitalizations compared to standard of care. Aim of the study was to assess the cost-effectiveness of sacubitril/valsartan compare to enalapril. MethOds: A 2-state Markov model, with 'alive' and 'dead' states, was developed to predict the effect of treatment options in terms of CV Mortality, Hospitalisation and Health-related quality of life (HRQL). The economic model is structured as a regression-based cohort model. Based on the data of the PARADIGM-HF clinical trial, CV Mortality was estimated using parametric survival curves, Hospitalization rates were estimated using a negative binomial regression model and HRQL was estimated as a longitudinal analysis of EQ-5D values using a mixed-effects regression model. The model estimated costs, Life Years (LYs) and Quality-Adjusted Life Years (QALY) using 30 year time horizon and the Italian NHS perspective. Results were presented as incremental cost-effectiveness ratios (ICERs) per QALY gained. Cost and outcomes were discounted at 3.5%. Results: The model reported a better survival in the patients treated with sacubitril/valsartan compare to enalapril, with an improvement of 0.30 LY and 0.26 QALY gained. The treatment cost with sacubitril/valsartan (assumed because not yet available in Italy) increased the overall cost that is partially offset by the reduction of the hospitalization costs. Comparing the difference in costs and QALYs, sacubitril/valsartan results as the cost-effectiveness option with an ICER of € 22,431 below the willingness to pay threshold of € 50,000 usually applied in Italy. cOnclusiOns: Sacubitril/valsartan is a cost-effective treatment option in Heart Failure patients with Reduced Ejection Fraction. Future investigations that incorporate real-world evidence with sacubitril/ valsartan are required to confirm these results.

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