Alexander T Sandhu1, Daniel A Ollendorf1, Richard H Chapman1, Steven D Pearson1, Paul A Heidenreich1. 1. From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, and Stanford University School of Medicine, Stanford, California; and Institute for Clinical and Economic Review, Boston, Massachusetts.
Abstract
BACKGROUND: Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction. OBJECTIVE: To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure. DESIGN: Markov decision model. DATA SOURCES: Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables. TARGET POPULATION: Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Treatment with sacubitril-valsartan or lisinopril. OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure. RESULTS OF SENSITIVITY ANALYSIS: Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained. LIMITATION: The benefit of sacubitril-valsartan is based on a single clinical trial. CONCLUSION: Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.
BACKGROUND: Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction. OBJECTIVE: To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure. DESIGN: Markov decision model. DATA SOURCES: Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables. TARGET POPULATION: Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Treatment with sacubitril-valsartan or lisinopril. OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure. RESULTS OF SENSITIVITY ANALYSIS: Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained. LIMITATION: The benefit of sacubitril-valsartan is based on a single clinical trial. CONCLUSION: Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.
Authors: Dhruv S Kazi; Brandon K Bellows; Suzanne J Baron; Changyu Shen; David J Cohen; John A Spertus; Robert W Yeh; Suzanne V Arnold; Brett W Sperry; Mathew S Maurer; Sanjiv J Shah Journal: Circulation Date: 2020-02-12 Impact factor: 29.690
Authors: Paul A Heidenreich; Gregg C Fonarow; Yekaterina Opsha; Alexander T Sandhu; Nancy K Sweitzer; Haider J Warraich Journal: J Card Fail Date: 2022-01-24 Impact factor: 6.592
Authors: Brystana G Kaufman; Bradi B Granger; Jie-Lena Sun; Gillian Sanders; Donald H Taylor; Daniel B Mark; Haider Warraich; Mona Fiuzat; Karen Steinhauser; James A Tulsky; Joseph G Rogers; Christopher O'Connor; Robert J Mentz Journal: J Card Fail Date: 2021-03-14 Impact factor: 6.592
Authors: Alexander T Sandhu; Paul A Heidenreich; John Lin; Justin Parizo; Jay Bhattacharya; Jeremy D Goldhaber-Fiebert Journal: Circ Cardiovasc Qual Outcomes Date: 2022-01-18
Authors: Nicolas Isaza; Paola Calvachi; Inbar Raber; Chia-Liang Liu; Brandon K Bellows; Inmaculada Hernandez; Changyu Shen; Michael C Gavin; A Reshad Garan; Dhruv S Kazi Journal: JAMA Netw Open Date: 2021-07-01