[Translated article] Cost-utility of sacubitril/valsartan in heart failure with reduced ejection fraction in Spain

Heart failure is an increasingly common syndrome with a rising prevalence, which associates significant costs, mainly related to hospitalization. In fact, heart failure is the most frequent diagnosis in hospital discharges in Spain. To analyze the economic impact of new treatments for heart failure with reduced ejection fraction such as sacubitril/valsartan in out-patient and in-patient setting. The present economic evaluation study was carried out by developing a Markov model. Treatment with sacubitril/valsartan from admission or after hospital discharge was compared, with enalapril being the comparator. Total costs, years of life gained, quality-adjusted life years, and incremental cost-effectiveness ratio and incremental cost-utility ratio were analyzed. Data were obtained from the PARADIGM-HF and PIONEER-HF studies. The results of the base cases of the three comparisons made showed that sacubitril/valsartan produced benefits in years of life gained and quality-adjusted life years compared to enalapril showing incremental cost-utility ratio below €20,000/QALY and that this ratio was better in scenarios starting sacubitril/valsartan in the hospital setting once decompensation was resolved. This study shows that starting sacubitril/valsartan from hospital admission for heart failure is cost-effective from the perspective of the National Health Service in Spain.