Real-World Cost-Effectiveness of Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure With Reduced Ejection Fraction in Korea

BACKGROUND AND OBJECTIVES: Heart failure with reduced ejection fraction (HFrEF) poses a significant burden on healthcare systems worldwide. We evaluated the real-world cost-effectiveness of angiotensin receptor-neprilysin inhibitor (ARNI) compared with traditional renin-angiotensin system (RAS) blockade in patients with HFrEF in the Korean setting. METHODS: A partitioned survival model was developed based on the PARADE-HF study, which evaluated the effectiveness of ARNI in Korean HFrEF patients using National Health Insurance claims data. The model estimated medical costs, hospitalizations, life-years, and quality-adjusted life-years (QALYs) over a lifetime. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). RESULTS: The use of ARNI resulted in additional 0.54 life-years, 0.25 QALYs gained, fewer hospitalizations (25.91 vs. 26.40) per 1,000 person-years, and an added cost of $2,880 per patient. The ICER was $11,365/QALY for all patients and $9,421/QALY for elderly patients (≥75 years). At a $20,000/QALY threshold of the willingness to pay, cost-effectiveness probabilities were 68% in all patients and 88% in elderly patients. CONCLUSIONS: In the real world, ARNI demonstrated superior cost-effectiveness compared with traditional RAS blockade in patients with HFrEF, with particularly pronounced benefits in elderly patients aged ≥75 years. The favorable cost-effectiveness profile, combined with significant reductions in mortality and hospitalization, supports the broader adoption of ARNI in clinical practice, especially for elderly patients despite concerns about tolerability in this population.