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

Abstract

Objectives: Heart failure with reduced ejection fraction (HFrEF) is a major health concern globally due to high mortality rates, frequent hospitalization and considerable medical expenditure. The prevalence of HFrEF is steadily rising in Asian countries, and populous, developing countries like China are facing a significant socioeconomic burden as a result. Sacubitril-valsartan (Sac-Val) is currently a class I recommendation for treating HFrEF in major guidelines, although it has not been pharmaco-economically evaluated in China. To this end, we compared the cost-effectiveness of Sac-Val and enalapril based on the negotiated prices in order to fully assess the expected costs and benefits of the clinical use of Sac-Val in China. Method: A Markov model was constructed to estimate long-term clinical and economic outcomes of Sac-Val versus enalapril for HFrEF patients in China over a 10-year horizon. Primary model outcomes were total costs and quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results: Treatment with Sac-Val resulted in 4.67 QALYs at the cost of $4,684.25, while enalapril yielded 4.40 QALYs at the cost of $4,014.47. Compared to enalapril, Sac-Val was associated with a gain of 0.27 QALYs, resulting in an ICER of $ 2,480.67 per QALY. Deterministic sensitivity analysis showed robust results. Probabilistic sensitivity analysis suggested that Sac-Val has a 99.99% probability of being cost-effective at the willingnessto-pay threshold of $10,276. Conclusion: From Chinese patients' perspective, Sac-Val is a cost-effective treatment option for HFrEF in China compared to enalapril. Our findings can aid clinicians plan the Sac-Val regimen, as well as decision makers to discuss the value and position of novel angiotensin receptor neprilysin inhibitors (ARNIs) in future.

Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials

“…Even though sacubitril-valsartan has been proven cost-effective in patients with HF in China ( 42 ), adding sacubitril-valsartan to the standard treatment of hypertension still needs investigating. In our study, we found that sacubitril-valsartan was cost-effective in treating hypertension in the current China setting, despite starting age or time horizon.…”

“…Sacubitril-valsartan was approved to treat heart failure by the China National Medical Products Administration (NMPA) in 2017 ( 42 ); the proportion of sacubitril-valsartan in RAASi was 2.3% at that time, but it has increased to 63.7% in 2020 as sacubitril-valsartan was included in the joint purchasing list ( 24 ). Sacubitril-valsartan was recommended as antihypertensive drug by the Chinese expert recommendations in 2021, and was approved to treat hypertension by the NMPA a few months later ( 12 ).…”

Cost-Effectiveness of Adding SGLT2 Inhibitors to Standard Treatment for Heart Failure With Reduced Ejection Fraction Patients in China

“…We constructed a Markov model for cost-utility analysis to compare the economics of three standard treatment options: standard treatment; adding dapagliflozin (10 mg, once daily) to the standard treatment; and adding empagliflozin (10 mg, once daily) to standard treatment. Based on the characteristics of the natural course of HFrEF and the availability of inter-state transition probability, this study set HFrEF patients into the following five states: New York Heart Association (NYHA) function classifications I, II, III, and IV and death, among which the death state was in the absorption state ( Wu et al, 2020 ). Since the risk of readmission in the vulnerable period of HF was much higher than that in the stable period ( Greene et al, 2015 ), we assumed that in our model, all patients who had experienced high-frequency hospitalizations had HF readmissions within 3 months.…”

Cost effectiveness analyses of pharmacological treatments in heart failure

“…It should be noted that there are few studies that evaluate treatment time horizon and hospitalisation costs. Furthermore, there is clearly a lack of studies that model rehospitalisation changes explicitly, only one study in this review included hospital readmissions in its cost evaluation ( Wu et al, 2020 ). This is empirical in the case of HF as patients with HF who have previously been hospitalised have elevated rehospitalisation rates and increased care costs ( Rohde et al, 2013 ).…”