Heart failure & cardiomyopathiesMeta-analysis
A NETwork meta-analysis with COST-effectiveness evaluation of pharmacological treatments for heart failure with reduced ejection fraction: NET-COST-HFrEF
- Network meta-analysis of randomised trials with cost-effectiveness analysis
- random-effects
- decision tree-Markov model
Authors' conclusion
Quadruple therapy with ARNI+BB+MRA+SGLT2i had the highest probability of being the most cost-effective strategy.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) in randomized controlled trials (RCTs) of drugs in settings recommended by the 2021 ESC HF guidelines; United Kingdom (UK) (main), Sweden and United States (US) healthcare perspectives
- Participants
- 75,978 patients · 47 RCTs
- Comparison
- Guideline-directed pharmacological treatment strategies for HFrEF
- Outcome
- All-cause mortality and total HF hospitalizations (main efficacy outcomes); cost-effectiveness
Pooled result
As reported in the abstract
Cost-effectiveness (UK perspective)
| Group | Quality-adjusted life-years | Net monetary benefit |
|---|---|---|
| Angiotensin receptor-neprilysin inhibitor (ARNI)+BB+mineralocorticoid receptor antagonist (MRA)+SGLT2i | 12.31 | £338,460 |
Further pooled results
Scenario analyses (Sweden, US)
- Findings consistent in Sweden and US
Original publication
A NETwork meta-analysis with COST-effectiveness evaluation of pharmacological treatments for heart failure with reduced ejection fraction: NET-COST-HFrEF. Eur J Heart Fail. Published 16 July 2026. doi:10.1093/ejhf/xuag233
Summarised from the published abstract; every number is checked against it