Heart failure & cardiomyopathiesCohort study
Model-based cost-effectiveness analysis of first-line pharmacotherapy combinations in adults with chronic heart failure and reduced ejection fraction
- lifetime cohort Markov model
- from the perspective of the NHS in England
Authors' conclusion
This study demonstrates that a first-line quadruple pharmacotherapy combination is cost-effective compared with a stepwise approach for treating people with HFrEF, suggesting that wider adoption of early initiation of quadruple pharmacotherapy may improve health outcomes and optimise healthcare resource use.
Study context
- Population
- Adults with chronic heart failure with reduced ejection fraction (HFrEF)
- Exposure
- cost-effectiveness of five first-line pharmacotherapy combinations
Main finding
As reported in the abstract
Cost-effectiveness among individuals able to tolerate an ACEI · lifetime
| Group | cost | Quality-adjusted life years (QALYs) |
|---|---|---|
| Angiotensin-converting enzyme inhibitor (ACEI), beta-blocker (BB), mineralocorticoid receptor antagonists (MRA) and SGLT2i | £12 124 | 5.72 |
- most cost-effective first-line treatment option; Incremental cost-effectiveness ratio (ICER)
- £7699
Observational data: associations, not effects.
Further findings
| Outcome | ARNI, BB, MRA and SGLT2i | ARB, BB, MRA and SGLT2i |
|---|---|---|
| Cost-effectiveness among individuals unable to tolerate an ACEI · lifetime | ||
| cost | £18 950 | £11 842 |
| QALYs | 6.04 | 5.59 |
- Cost-effectiveness among individuals unable to tolerate an ACEI — angiotensin receptor-neprilysin inhibitor (ARNI), BB, MRA and SGLT2i most cost-effective first-line treatment option; ICER
- £15 821
Cost-effectiveness among individuals unable to tolerate an ACEI · lifetime
- Angiotensin receptor blocker (ARB), BB, MRA and SGLT2i next most cost-effective first-line treatment option
- findings primarily driven by the greater relative QALY gain of ARNI compared with ARB
Original publication
Model-based cost-effectiveness analysis of first-line pharmacotherapy combinations in adults with chronic heart failure and reduced ejection fraction. Heart. Published 11 March 2026. doi:10.1136/heartjnl-2025-327190
Summarised from the published abstract; every number is checked against it