Cost-Effectiveness Analysis of Sacubitril/Valsartan for the Treatment of Heart Failure with Reduced Ejection Fraction in the United States
| Autor: | Robert J. DiDomenico, Varun M. Kumar, Rachel Harrington, Alicia Atwood, Daniel R. Touchette, Gianna C. Rigoni, Patrick M. Zueger |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness Cost-Benefit Analysis Tetrazoles 030204 cardiovascular system & hematology Drug Costs Sacubitril Cohort Studies Angiotensin Receptor Antagonists 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Pharmacology (medical) 030212 general & internal medicine Enalapril health care economics and organizations Heart Failure Ejection fraction business.industry Aminobutyrates Biphenyl Compounds Stroke Volume Cost-effectiveness analysis Markov Chains Quality-adjusted life year Hospitalization Drug Combinations Valsartan Cardiology Quality-Adjusted Life Years business Sacubitril Valsartan medicine.drug |
| Zdroj: | Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 38:520-530 |
| ISSN: | 0277-0008 |
| DOI: | 10.1002/phar.2108 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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