Heart failure & cardiomyopathiesResearch article
Health and Economic Evaluation of Sacubitril-Valsartan for Heart Failure Management
- Economic evaluation (cost-effectiveness analysis) using participant-level data from the PARADIGM-HF and PARAGON-HF trials
- 5-state Markov model
- lifetime horizon
- health care sector perspective
- probabilistic sensitivity analysis
Authors' conclusion
Cost-effectiveness modeling provided an ICER for treatment with sacubitril-valsartan vs RASis consistent with high economic value for patients with reduced and mildly reduced EFs (≤50%) and at least intermediate value at the current undiscounted wholesale acquisition cost price at an EF of 60% or less. Treatment was more cost-effective at lower EF ranges.
Study context
- Population
- Patients with chronic heart failure (HF), ejection fraction (EF) distribution of US patients with HF from the Get With the Guidelines-Heart Failure registryanalysed
- Participants
- 13,264 patients
- Comparison
- Sacubitril-valsartan vs renin-angiotensin system inhibitors (RASis)
- Outcome
- ICER (cost per QALY) at EF ≤60% (base case) and at various upper-level EF cutoffs
- Follow-up
- Lifetime horizon
Main finding
ICER at EF ≤60% (base case) · lifetime
ICER
$76 852 per QALY
95% CI $71 516 and $82 970
As reported in the abstract
Further findings
ICER by upper-level EF cutoff
- EF ≤55%
- $67 331 per QALY
- EF ≤50%
- $59 614 per QALY
- EF ≤45%
- $56 786 per QALY
- EF ≥45% (up to ≤60%) only
- $127 172 per QALY gained
- EF 45%-55%
- $100 388 per QALY gained
- EF 45%-50%
- $84 291 per QALY gained
Price thresholds for sacubitril-valsartan value (EF ≤60%)
- At least intermediate value (ICER <$180 000 per QALY) at cost per year
- $10 242 or less
- High value (ICER <$60 000 per QALY) at cost per year
- $3673 or less
- Cost-saving at cost per year
- $338 or less
Original publication
Health and Economic Evaluation of Sacubitril-Valsartan for Heart Failure Management. JAMA Cardiol. Published 1 November 2023. doi:10.1001/jamacardio.2023.3216
Summarised from the published abstract; every number is checked against it