A cost-effective analysis of sacubitril-valsartan treatment in patients with New York Heart Association (NYHA) class II- to IV heart-failure found the treatment can provide a reasonable value in reducing mortality and morbidity.
The PARADIGM-HF trial (n=8,442) found that sacubitril-valsartan reduced cardiovascular mortality, hospitalizations and improved QoL. However, the cost of sacubritril-valsartan is substantially greater than that of generic angiotensin-converting enzyme inhibitors (ACEI).
The researchers used the subject cohort of the PARADIGM-HF trial to assess the cost-effectiveness of sacubitril-valsartan.
Results showed that the lisinopril group had an average of 5.71 quality-adjusted life-years (QALYs) and lifetime costs of $131,581, whereas the sacubitril-valsartan group had an additional 0.62 QALY and $29,203 in costs. The cost per QALY gained with sacbitril-valsartan was $47,053. The author’s acknowledge this finding is based on a single trial (PARADIGM-HF) however it was robust in sensitivity analyses across model parameters.
Over a median follow-up time of 27 months, the sacubitril–valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-years, 0.62 additional QALY, and $29,203 in incremental costs. The cost per QALY gained was $44,531 and $58,194 in patients with NYHA class II and class III/IV heart failure, respectively.
The authors suggest that the increased survival of 0.69 year, “may justify the increase in treatment costs, depending on the societal willingness to pay.” They conclude by highlighting how their results were robust to sensitivity analyses that support the adoption of sacubitril-valsartan therapy.
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