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Sacubitril–valsartan cost-effective for patients with heart failure

Sacubitril–valsartan therapy offers a reasonable value for patients with chronic heart failure to reduce cardiovascular mortality and morbidity, according to recent research.

Alexander T. Sandhu, MD, MS, of Stanford University Center for Primary Care and Outcomes Research, and colleagues used a Markov decision model to assess the cost-effectiveness of sacubitril–valsartan vs. lisinopril.

The study cohort was based on the PARADIGM-HF trial population and included patients (mean age, 64 years) with New York Heart Association (NYHA) class II to IV heart failure, and reduced ejection fraction of 0.4 or less.

Patients received either 200 mg of sacubitril–valsartan twice daily or 20 mg of lisinopril once daily.

Results showed that patients treated with sacubitril–valsartan experienced 0.08 fewer heart failure hospitalizations, 0.69 additional life-years, and 0.62 additional quality-adjusted life-years (QALY). Furthermore, incremental costs totaled $29,203 with an increase of $47,053 cost per QALY.

A total of $44,531 and $58,194 was gained in cost per QALY in patients with NYHA class II heart failure and class III or IV heart failure, respectively.

The sacubitril–valsartan group was most sensitive to the length of effectiveness of the treatment. Cost per QALY increased to $120,623 if the duration was limited to the trial period (median, 27 months). In addition, if the treatment was effective for at least 36 months, the cost per QALY did not exceed $100,000.

“Our analysis indicates that sacubitril–valsartan is a cost-effective therapy for patients with NYHA class II to IV heart failure and reduced ejection fraction,” Sandhu and colleagues concluded. “The evidence of efficacy is based on a single trial, but our findings were robust in sensitivity analyses across model parameters.”

In an accompanying editorial, Milton Packer, MD, of Baylor Heart and Vascular Institute and the department of medicine, Baylor University Medical Center, and colleagues outlined their doubts that this study will persuade physicians to start prescribing sacubitril–valsartan if they are not already doing so.

“A lack of convincing data is not the issue with sacubitril–valsartan; the evidence is compelling,” Packer and colleagues wrote. “Many physicians are too busy caring for patients to spend time reading research reports on new and unfamiliar drugs. Furthermore, even if physicians were to read the findings of a new study, they are likely to encounter data that are presented in an opaque and unpersuasive manner. This is a lesson the academic clinical community needs to hear and take to heart.” – by Alaina Tedesco

Disclosures: The researchers report funding by the US Department of Veterans Affairs and Institute for Clinical and Economic Review. Please see the full study for a complete list of all authors’ relevant financial disclosures.