Cost-effectiveness of sacubitril/valsartan in chronic heart-failure patients with reduced ejection fraction

Abstract

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.

Cost-Effectiveness of Sacubitril/Valsartan in Germany: An Application of the Efficiency Frontier

“…Compared to previously-published ICERs for European countries, which range from €17,600 to €23,401 with an average of €20,676, our ICER for Germany is within this range. [20][21][22][23][24][25] For Germany, Gandjour and Ostwald calculated an ICER of €23,401, a small difference when regarding their very different model design: the included discounts on sacubitril/valsartan, their inclusion of indirect medical costs and their adjustments to the PARADIGM-HF mortality rates, based on Germany-specific data. 25 This analysis has a number of limitations, first of all, for the inclusion of candesartan and placebo, we focused on the model parameters with the largest impact on the results: mortality and hospitalizations, as data on the other inputs were not available in scientific literature.…”

“…If the ICER would instead be used to assess the cost-effectiveness of sacubitril/valsartan in the German context, it would most likely be deemed cost-effective at market entry, as reported for other European countries. [20][21][22][23][24] This comparison marks a major difference in conclusions decision makers would draw using either the ICER or EF approach. If we consider a fixed budget for CHF alone, the EF may provide more relevant information for decision makers: the health gains per euro will not decrease as long as the treatment is on or above the frontier.…”

“…19 Subsequent to the approval of sacubitril/valsartan by the EMA, pharmacoeconomic evaluations have been published for many other European countries. [20][21][22][23][24] In a previous study from the Dutch perspective, we concluded that sacubitril/valsartan was cost-effective. 20 To date, one analysis for Germany has been published, reporting an ICER of €23,401 per life-year gained.…”

Sacubitril-Valsartan Compared With Enalapril for the Treatment of Heart Failure: A Decision-Analytic Markov Model Simulation in China

“…Several studies have compared the cost-effectiveness of Sac-Val and enalapril in developed countries. Owing to the high WTP threshold, Sac-Val is cost-effective in countries like United States ( Gaziano et al, 2016 ; King et al, 2016 ; Sandhu et al, 2016 ), Netherlands ( van der Pol et al, 2017 ), United Kingdom ( McMurray et al, 2018 ) and other European countries ( Zanfina et al, 2017 ; Gandjour and Ostwald, 2018 ; McMurray et al, 2018 ; van der Pol et al, 2019 ), even with high estimated ICERs. In contrast, opposite conclusions were drawn in similar studies conducted in Singapore ( Liang et al, 2018 ) and Thailand ( Krittayaphong and Permsuwan, 2018 ).…”

“…Apart from the therapeutic effects, the results from PARADIGM-HF have also been used for evaluating the economic viability of Sac-Val ( Liu et al, 2020 ), especially in the developed countries ( Gaziano et al, 2016 ; King et al, 2016 ; Sandhu et al, 2016 ; van der Pol et al, 2017 ; Zanfina et al, 2017 ; Gandjour and Ostwald, 2018 ; Krittayaphong and Permsuwan, 2018 ; Liang et al, 2018 ; Zueger et al, 2018 ; Park et al, 2019 ; van der Pol et al, 2019 ). Owing to the high willingness-to-pay (WTP) threshold, Sac-Val is likely to be cost-effective compared to enalapril in United States ( Gaziano et al, 2016 ; King et al, 2016 ; Sandhu et al, 2016 ), United Kingdom ( McMurray et al, 2018 ) and some other European countries ( Zanfina et al, 2017 ; Gandjour and Ostwald, 2018 ; McMurray et al, 2018 ; van der Pol et al, 2019 ) despite the higher acquisition cost. However, few studies have evaluated the pharmaco-economics of Sac-Val in the low and middle-income Asian countries.…”