Cost‐Effectiveness of Ivabradine for Heart Failure in the United States

Abstract

BackgroundIvabradine is a heart rate–lowering agent approved to reduce the risk of hospitalization for worsening heart failure. This study assessed the cost‐effectiveness of adding ivabradine to background therapy in the United States from the perspective of a commercial or Medicare Advantage payer.Methods and ResultsA cost‐effectiveness, cohort‐based Markov model using a state transition approach tracked a cohort of heart failure patients with heart rate ≥70 beats per minute in sinus rhythm who were treated with ivabradine+background therapy or background therapy alone. Model inputs, including adjusted hazard ratios, rates of hospitalization and mortality, adverse events, and utility‐regression equations, were derived from a large US claims database and SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial). In the commercial population, ivabradine+background therapy was associated with a cost savings of $8594 versus the cost of background therapy alone over a 10‐year time horizon, primarily because of reduced hospitalization. Ivabradine was associated with an incremental benefit of 0.24 quality‐adjusted life years over a 10‐year time horizon. In the Medicare Advantage population, the incremental cost‐effectiveness ratio for ivabradine was estimated to be $24 920/quality‐adjusted life years.ConclusionsThe cost‐effectiveness model suggests that for a commercial population, the addition of ivabradine to background therapy was associated with cost savings and improved clinical outcomes. For a Medicare Advantage population, the analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost.

Evaluating Cost-Effectiveness Models for Pharmacologic Interventions in Adults with Heart Failure: A Systematic Literature Review

“…Altogether, the geographic regions of the populations in the 64 publications encompassed 15 different countries: the most commonly identified nations included the USA ( n = 16 [25%]) [15–30], the UK ( n = 16 [25%]) [31–46] and Canada ( n = 5 [8%]) [24, 47–50]. A total of 48 (75%) publications included in this review reported their source of funding [15, 16, 18, 22, 24–35, 37–42, 44, 45, 47, 48, 50–71]. Of the included publications, the most commonly reported pharmacologic treatments administered to patients with HF included eplerenone ( n = 12 [19%]), ramipril ( n = 11 [17%]) enalapril ( n = 8 [13%]) and ivabradine ( n = 6 [9%]).…”

“…Most of the publications provided reasonable details in relation to the types of modelling approaches employed (Table 1). The most common modelling approaches used included a Markov cohort model type ( n = 28 [41%]) [15, 17, 19, 22, 23, 26, 27, 32–34, 38–40, 44, 48, 49, 51, 52, 58, 66–69, 72–76]. Given the versatility of the Markov model approach in adopting different types of health states patients can potentially experience, this method was further categorized into health state classifications.…”

Cost‐Effectiveness Analysis of Sacubitril/Valsartan for the Treatment of Heart Failure with Reduced Ejection Fraction in the United States

“…Pharmacologic therapies, particularly “standard of care” treatments such as ACEI, ARBs, and beta‐blockers, are generally highly cost‐effective (ICER < $10,000/QALY gained) . Ivabradine, approved in the United States in 2015 for HFrEF, is estimated to provide both a cost‐savings and QALY benefit compared with standard of care among the commercially insured, and is cost‐effective ($24,920/QALY gained) among Medicare Advantage patients . Eplerenone, an aldosterone antagonist, has been demonstrated as consistently cost‐effective (ICER < $50,000/QALY gained) compared with standard of care in the post‐myocardial infarction HF population, with some estimates as low as $11,393/QALY gained .…”

“…40,41 Ivabradine, approved in the United States in 2015 for HFrEF, is estimated to provide both a cost-savings and QALY benefit compared with standard of care among the commercially insured, and is cost-effective ($24,920/ QALY gained) among Medicare Advantage patients. 42 Eplerenone, an aldosterone antagonist, has been demonstrated as consistently costeffective (ICER < $50,000/QALY gained) compared with standard of care in the post-myocardial infarction HF population, with some estimates as low as $11,393/QALY gained. 43,44 Nonpharmacologic therapies such as cardiac resynchronization therapy and implantable cardioverter defibrillators are generally cost-effective, with ICERs ranging from $20,000 to $90,000/QALY gained.…”

Cost‐effectiveness of a cardiac contractility modulation device in heart failure with normal QRS duration

“…We fitted six standard functions (exponential, Weibull, Gompertz, log‐normal, log‐logistic, and generalized gamma) to the observable data, with the final choice for the base case analysis made on the basis of Akaike information criterion and Bayesian information criterion scores. Mortality rates in the model population never went below those in the general English population because, in these cases, the model was programmed to use general population mortality data adjusted for cardiovascular mortality …”