Sacubitril/Valsartan (LCZ696): A Novel Treatment for Heart Failure and its Estimated Cost Effectiveness, Budget Impact, and Disease Burden Reduction in Germany

Gandjour, Afschin; Ostwald, Dennis A.

doi:10.1007/s40273-018-0688-4

Cited by 25 publications

(28 citation statements)

References 29 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…20 To date, one analysis for Germany has been published, reporting an ICER of €23,401 per life-year gained. 25 However, the article by Gandjour and Ostwald does not include a comparison to the EF. 25 We aim to assess the use of the EF for sacubitril/valsartan, an intervention, which replaces the broadly available generic drug classes: angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB).…”

Section: Introductionmentioning

confidence: 99%

“…25 However, the article by Gandjour and Ostwald does not include a comparison to the EF. 25 We aim to assess the use of the EF for sacubitril/valsartan, an intervention, which replaces the broadly available generic drug classes: angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). This includes the assessment of the cost-effectiveness of sacubitril/valsartan in Germany, using a previously developed model, adapted to incorporate the EF, according to German guidelines.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Using the German HTA guidelines, the ICER is not taken into consideration. Instead, the efficiency frontier was introduced as an alternative, to avoid the use of QALYs and the setting of willingness-to-pay thresholds. • We conducted the first direct comparison of the German efficiency frontier methodology to the conventional ICER, using sacubitril/valsartan, a new treatment for patients with chronic heart failure with a reduced ejection fraction. • Sacubitril/valsartan has a favourable ICER in the German setting, comparable to other European countries. However, using the efficiency frontier, the results would inform decision makers that a considerable discount needs to be negotiated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Fifth, we calculated the ICER for additional future costs that were unrelated to heart failure. Applying an additional €7,275 per year for individuals aged 65-84 years and €16,616 for individuals over 85 years [45] resulted in an ICER of €34,460 per additional QALY.…”

Section: Scenario Analysismentioning

confidence: 99%

Cardiac Resynchronisation Therapy in Patients with Moderate to Severe Heart Failure in Germany: A Cost-Utility Analysis of the Additional Defibrillator

Hadwiger

Frielitz

Eisemann

et al. 2020

Appl Health Econ Health Policy

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Background Cardiac resynchronisation therapy (CRT) is a well-established form of treatment for patients with heart failure and cardiac dyssynchrony. There are two different types of CRT devices: the biventricular pacemaker (CRT-P) and the biventricular defibrillator (CRT-D). The latter is more complex but also more expensive. For the majority of patients who are eligible for CRT, both devices are appropriate according to current guidelines. The purpose of this study was to conduct a cost-utility analysis for CRT-D compared to CRT-P from a German payer's perspective. Methods A cohort Markov-model was developed to assess average costs and quality-adjusted life-years (QALY) for CRT-D and CRT-P. The model consisted of six stages: one for the device implementation, one for the absorbing state death, and two stages ("Stable" and "Hospital") for either a CRT device or medical therapy. The time horizon was 20 years. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted. Results The incremental cost-effectiveness ratio (ICER) of CRT-D compared with CRT-P was €24,659 per additional QALY gained. In deterministic sensitivity analysis, the survival advantage of CRT-D to CRT-P was the most influential input parameter. In the probabilistic sensitivity analysis 96% of the simulated cases were more effective but also more costly. Conclusions Therapy with CRT-D compared to CRT-P resulted in an additional gain of QALYs, but was more expensive. In addition, the ICER was subject to uncertainty, especially due to the uncertainty in the survival benefit. A randomised controlled trial and subgroup analyses would be desirable to further inform decision making.

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“…Information on actual ICER threshold levels in the various therapeutic areas is therefore limited and may only be cautiously derived from CEAs that have been conducted for other purposes. For example, in patients with heart failure the ICER threshold for a new, innovative product is estimated at €23,401 per life-year gained [21], assuming that sacubitril/valsartan and enalapril would be appropriate comparators and that the CEA comparing sacubitril/valsartan to enalapril [21] would fulfil IQWiG's requirements.…”

Section: Introductionmentioning

confidence: 99%

Willingness to pay for new medicines: a step towards narrowing the gap between NICE and IQWiG

Gandjour

2020

BMC Health Serv Res

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Background: The question of how to set the cost-effectiveness threshold for new, innovative medicines is a matter of ongoing controversy. One prominent proposal suggests that the cost-effectiveness threshold adopted by the U.K. National Institute for Health and Care Excellence (NICE) should represent the opportunity cost for the U.K. National Health Service resulting from the adoption of new medicines. The purpose of this article is to compare this proposal for the U.K. with the approach chosen by the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, which relies on indication-specific cost-effectiveness thresholds. Main text: The 'ideal' NICE and IQWiG surprisingly share the fundamental principle of inferring the willingness to pay from existing care. For this and other reasons, indication-specific thresholds based on IQWiG's methodology do not lead to more inefficiency at the health system's level than a generic threshold based on the 'ideal' NICE (keeping other conditions the same). Also, applying either decision rule to one country will yield a similar long-term growth in population spending. Assuming that everything else is equal, both decision rules are predicted to decrease long-term expenditure growth. Convergence of the two decision rules would require, among others, ruling out waste in the 'ideal' NICE's approach and, for IQWiG's approach, using the same relative weights for life expectancy and health-related quality of life as the quality-adjusted-life-year model. Conclusion: This article shows that both decision rules have notable commonalities in terms of inferring the willingness to pay from existing care and the projected impact on long-term growth in population spending.

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Sacubitril/Valsartan (LCZ696): A Novel Treatment for Heart Failure and its Estimated Cost Effectiveness, Budget Impact, and Disease Burden Reduction in Germany

Abstract: The ICER of sacubitril/valsartan is projected to be at or below the level of other accepted interventions for the treatment of asymptomatic to severe heart failure in Germany. Projected budget impact leads to an increase in SHI expenditures by < 0.04% per year.

Cited by 25 publications

References 29 publications

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

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

Cardiac Resynchronisation Therapy in Patients with Moderate to Severe Heart Failure in Germany: A Cost-Utility Analysis of the Additional Defibrillator

Willingness to pay for new medicines: a step towards narrowing the gap between NICE and IQWiG

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