Key result
Vericiguat plus prior standard-of-care therapies was estimated to be cost-effective compared with standard care alone, resulting in an incremental cost of $82,448 per QALY gained.
Why the study?
Given the high economic burden in US adult patients with chronic HFrEF after a worsening heart failure event, the study evaluated the cost effectiveness of vericiguat from a US Medicare perspective.
Does vericiguat plus standard-of-care therapy improve quality-adjusted life-years cost-effectively compared to standard-of-care alone in adult patients with HFrEF following a worsening heart failure event?
Does vericiguat plus standard-of-care therapy improve quality-adjusted life-years cost-effectively compared to standard-of-care alone in adult patients with HFrEF following a worsening heart failure event?
Vericiguat added to standard-of-care therapy is estimated to be cost-effective for patients with HFrEF following a worsening heart failure event at a $100,000 per QALY threshold from a US Medicare perspective.
May inform Medicare coverage for vericiguat in HFrEF; leaves open real-world validation of modeled QALY gains.
OBJECTIVE: Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective. METHODS: A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually. RESULTS: For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to $82,448 per QALY gained. CONCLUSIONS: Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained.
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Alsumali et al. (2021) studied Chronic heart failure with reduced ejection fraction (HFrEF) (n=5,050). Vericiguat vs. Prior standard-of-care therapies (PSoCT) alone was evaluated on Incremental cost per quality-adjusted life-year (QALY) gained. Vericiguat plus prior standard-of-care therapies was estimated to be cost-effective compared with standard care alone, resulting in an incremental cost of $82,448 per QALY gained.
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