Cost-Utility Analysis of Angiotensin Receptor–Neprilysin Inhibitor Sacubitril/Valsartan Compared with Ace Inhibitors for the Treatment of Chronic Heart Failure in the United States

Abstract

Objectives: Cardiovascular (CV) events are a leading cause of premature mortality and extended morbidity in Canada. While the direct costs of the burden of cardiovascular disease (CVD) are well-studied, the indirect costs due to lost productivity, caregiver burden, disability, and mortality are not as well understood. In order to characterize these costs, we conducted a literature review of the indirect costs of CVD in Canada. MethOds: A targeted literature review of the Ovid MEDLINE, Wiley's Cochrane Library, HEED, and Web of Science databases over the years 2000-2015 was conducted using MeSH terms and other keywords. Studies published in English, presenting indirect costs associated with CVD or CVD-related conditions in Canada were included. Costs were inflated to $2015 CDN dollars. Results: Out of 122 records identified by the literature search, 104 citations were excluded based on abstract screening. Full-text review of the remaining 18 studies resulted in the exclusion of 11 studies, while 7 studies were included for analysis. These 7 studies provided indirect costs associated with stroke (n= 3), myocardial infarction (n= 2), heart failure (n= 2), angina (n= 2) and coronary artery disease (n= 1). Most studies were prospective studies (n= 5) and estimated indirect costs in terms of productivity losses using the human capital method. Indirect costs ranged from $3 (heart failure) to $22,270 (stroke) per patient. cOnclusiOns: There are very few studies that have evaluated the indirect cost of CVD in Canada. In addition, the magnitude of the cost estimates varied widely between studies based on the patient population, availability of data, and calculation method selected.