Patrick M Zueger1, Varun M Kumar2, Rachel L Harrington1, Gianna C Rigoni1, Alicia Atwood3, Robert J DiDomenico4,5, Daniel R Touchette1,5. 1. Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois. 2. Institute for Clinical and Economic Review, Boston, Massachusetts. 3. Economics Department, University of Illinois at Chicago, Chicago, Illinois. 4. Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois. 5. Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
Abstract
OBJECTIVE: Sacubitril/valsartan (SAC/VAL) has been shown to reduce mortality and hospitalization in patients with heart failure with reduced ejection fraction (HFrEF) compared with enalapril but at a substantially higher cost. This study evaluates the cost-effectiveness of SAC/VAL versus enalapril in patients with HFrEF over a 5-year time horizon from the U.S. payer perspective. METHODS: A cohort-based Markov model was developed to compare costs and quality-adjusted life years (QALYs) between SAC/VAL and enalapril in patients with HFrEF over a 5-year time horizon. Markov states included New York Heart Association (NYHA) class (II-IV) and death. Treatment discontinuation, HF-related hospitalizations, and NYHA class progression were modeled as transition states based on data from the PARADIGM trial. Other probabilities, costs, and utilities were obtained from published literature and public databases. RESULTS: In the base case analysis, SAC/VAL cost more than enalapril ($81,943 vs $67,287) and was more effective (2.647 QALYs vs 2.546 QALYs), resulting in an incremental cost-effectiveness ratio of $143,891/QALY gained. At a willingness to pay (WTP) of $100,000/QALY, SAC/VAL was cost-effective up to a cost of $298/month. Results were most sensitive to SAC/VAL cost, SAC/VAL mortality benefit, and NYHA progression probability. SAC/VAL had a 10% and 52% probability of being cost-effective at WTP thresholds of $100,000/QALY and $150,000/QALY, respectively. CONCLUSIONS: SAC/VAL is associated with clinical benefit and may be cost-effective compared with the current standard of care over realistic treatment durations from the payer perspective. Results of this analysis can inform discussions on the value and position of SAC/VAL in the current market.
OBJECTIVE:Sacubitril/valsartan (SAC/VAL) has been shown to reduce mortality and hospitalization in patients with heart failure with reduced ejection fraction (HFrEF) compared with enalapril but at a substantially higher cost. This study evaluates the cost-effectiveness of SAC/VAL versus enalapril in patients with HFrEF over a 5-year time horizon from the U.S. payer perspective. METHODS: A cohort-based Markov model was developed to compare costs and quality-adjusted life years (QALYs) between SAC/VAL and enalapril in patients with HFrEF over a 5-year time horizon. Markov states included New York Heart Association (NYHA) class (II-IV) and death. Treatment discontinuation, HF-related hospitalizations, and NYHA class progression were modeled as transition states based on data from the PARADIGM trial. Other probabilities, costs, and utilities were obtained from published literature and public databases. RESULTS: In the base case analysis, SAC/VAL cost more than enalapril ($81,943 vs $67,287) and was more effective (2.647 QALYs vs 2.546 QALYs), resulting in an incremental cost-effectiveness ratio of $143,891/QALY gained. At a willingness to pay (WTP) of $100,000/QALY, SAC/VAL was cost-effective up to a cost of $298/month. Results were most sensitive to SAC/VAL cost, SAC/VAL mortality benefit, and NYHA progression probability. SAC/VAL had a 10% and 52% probability of being cost-effective at WTP thresholds of $100,000/QALY and $150,000/QALY, respectively. CONCLUSIONS: SAC/VAL is associated with clinical benefit and may be cost-effective compared with the current standard of care over realistic treatment durations from the payer perspective. Results of this analysis can inform discussions on the value and position of SAC/VAL in the current market.
Authors: András Incze; Zoltán Kaló; Jaime Espín; Éva Kiss; Sophia Kessabi; Louis P Garrison Journal: Front Pharmacol Date: 2022-04-06 Impact factor: 5.988
Authors: Audrey Huili Lim; Nusaibah Abdul Rahim; Jinxin Zhao; S Y Amy Cheung; Yu-Wei Lin Journal: Front Pharmacol Date: 2022-09-05 Impact factor: 5.988
Authors: Bruce L Wilkoff; Giuseppe Boriani; Suneet Mittal; Jeanne E Poole; Charles Kennergren; G Ralph Corey; Andrew D Krahn; Edward J Schloss; Jose L Gallastegui; Robert A Pickett; Rudolph F Evonich; Steven F Roark; Denise M Sorrentino; Darius P Sholevar; Edmond M Cronin; Brett J Berman; David W Riggio; Hafiza H Khan; Marc T Silver; Jack Collier; Zayd Eldadah; Reece Holbrook; Jeff D Lande; Daniel R Lexcen; Swathi Seshadri; Khaldoun G Tarakji Journal: Circ Arrhythm Electrophysiol Date: 2020-09-11