Jordan B King1, Rashmee U Shah2, Adam P Bress3, Richard E Nelson4, Brandon K Bellows5. 1. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah. Electronic address: jordan.king@pharm.utah.edu. 2. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah. 3. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah. 4. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah. 5. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah; SelectHealth, Salt Lake City, Utah.
Abstract
OBJECTIVES: The objective of this study was to determine the cost-effectiveness and cost per quality-adjusted life year (QALY) gained of sacubitril-valsartan relative to enalapril for treatment of heart failure with reduced ejection fraction (HFrEF). BACKGROUND: Compared with enalapril, combination angiotensin receptor-neprilysin inhibition (ARNI), as is found in sacubitril-valsartan, reduces cardiovascular death and heart failure hospitalization rates in patients with HFrEF. METHODS: Using a Markov model, costs, effects, and cost-effectiveness were estimated for sacubitril-valsartan and enalapril therapies for the treatment of HFrEF. Patients were 60 years of age at model entry and were modeled over a lifetime (40 years) from a third-party payer perspective. Clinical probabilities were derived predominantly from PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). All costs and effects were discounted at a 3% rate annually and are presented in 2015 U.S. dollars. RESULTS: In the base case, sacubitril-valsartan, compared with enalapril, was more costly ($60,391 vs. $21,758) and more effective (6.49 vs. 5.74 QALYs) over a lifetime. The cost-effectiveness of sacubitril-valsartan was highly dependent on duration of treatment, ranging from $249,411 per QALY at 3 years to $50,959 per QALY gained over a lifetime. CONCLUSIONS: Sacubitril-valsartan may be a cost-effective treatment option depending on the willingness-to-pay threshold. Future investigations should incorporate real-world evidence with sacubitril-valsartan to further inform decision making.
OBJECTIVES: The objective of this study was to determine the cost-effectiveness and cost per quality-adjusted life year (QALY) gained of sacubitril-valsartan relative to enalapril for treatment of heart failure with reduced ejection fraction (HFrEF). BACKGROUND: Compared with enalapril, combination angiotensin receptor-neprilysin inhibition (ARNI), as is found in sacubitril-valsartan, reduces cardiovascular death and heart failure hospitalization rates in patients with HFrEF. METHODS: Using a Markov model, costs, effects, and cost-effectiveness were estimated for sacubitril-valsartan and enalapril therapies for the treatment of HFrEF. Patients were 60 years of age at model entry and were modeled over a lifetime (40 years) from a third-party payer perspective. Clinical probabilities were derived predominantly from PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). All costs and effects were discounted at a 3% rate annually and are presented in 2015 U.S. dollars. RESULTS: In the base case, sacubitril-valsartan, compared with enalapril, was more costly ($60,391 vs. $21,758) and more effective (6.49 vs. 5.74 QALYs) over a lifetime. The cost-effectiveness of sacubitril-valsartan was highly dependent on duration of treatment, ranging from $249,411 per QALY at 3 years to $50,959 per QALY gained over a lifetime. CONCLUSIONS:Sacubitril-valsartan may be a cost-effective treatment option depending on the willingness-to-pay threshold. Future investigations should incorporate real-world evidence with sacubitril-valsartan to further inform decision making.
Authors: Gian Luca Di Tanna; Blake Angell; Michael Urbich; Peter Lindgren; Thomas A Gaziano; Gary Globe; Björn Stollenwerk Journal: Pharmacoeconomics Date: 2022-08-12 Impact factor: 4.558
Authors: Pratyaksh K Srivastava; Brian L Claggett; Scott D Solomon; John J V McMurray; Milton Packer; Michael R Zile; Akshay S Desai; Jean L Rouleau; Karl Swedberg; Gregg C Fonarow Journal: JAMA Cardiol Date: 2018-12-01 Impact factor: 14.676
Authors: Adam P Bress; Brandon K Bellows; Jordan B King; Rachel Hess; Srinivasan Beddhu; Zugui Zhang; Dan R Berlowitz; Molly B Conroy; Larry Fine; Suzanne Oparil; Donald E Morisky; Lewis E Kazis; Natalia Ruiz-Negrón; Jamie Powell; Leonardo Tamariz; Jeff Whittle; Jackson T Wright; Mark A Supiano; Alfred K Cheung; William S Weintraub; Andrew E Moran Journal: N Engl J Med Date: 2017-08-24 Impact factor: 91.245
Authors: Kelsey B Bryant; Andrew E Moran; Dhruv S Kazi; Yiyi Zhang; Joanne Penko; Natalia Ruiz-Negrón; Pamela Coxson; Ciantel A Blyler; Kathleen Lynch; Laura P Cohen; Gabriel S Tajeu; Valy Fontil; Norma B Moy; Joseph E Ebinger; Florian Rader; Kirsten Bibbins-Domingo; Brandon K Bellows Journal: Circulation Date: 2021-04-15 Impact factor: 39.918