Cost-effectiveness of Sacubitril-Valsartan in Hospitalized Patients Who Have Heart Failure With Reduced Ejection Fraction
Key result
Inpatient initiation of sacubitril-valsartan in HFrEF patients was associated with 116 fewer HF admissions per 1000 patients and an ICER of $21,532 per QALY compared with continued enalapril.
Why the study?
Sacubitril-valsartan reduces mortality and hospitalizations compared with enalapril in chronic HFrEF, but its cost-effectiveness when initiated during hospitalization was unknown.
Does inpatient initiation of sacubitril-valsartan improve cost-effectiveness and reduce hospitalizations compared with enalapril or delayed initiation in patients with HFrEF?
Population
Modeled US patients with stabilized HFrEF eligible for sacubitril-valsartan
Comparison
Inpatient sacubitril-valsartan vs enalapril, no initiation, or posthospitalization sacubitril-valsartan
Design
Economic evaluation using a 5-state Markov model
Follow-up
Lifetime horizon
Authors
Discussion
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Implication
Supports inpatient sacubitril-valsartan initiation in HFrEF; leaves open randomized confirmation of cost-effectiveness.
Key Points
- To evaluate the cost-effectiveness and budget impact of initiating sacubitril-valsartan during hospitalization versus continuing enalapril or delaying initiation in patients with heart failure with reduced ejection fraction.
- Constructed a 5-state Markov decision model tracking all-cause mortality and heart failure rehospitalizations among eligible US patients (mean age 63.8 years) from 2009 to 2018.
- Evaluated lifetime health and economic outcomes from healthcare and societal perspectives using Euro-QoL EQ-5D quality-of-life utilities and a 3% annual discount rate.
- Inpatient sacubitril-valsartan initiation led to 62 fewer heart failure readmissions per 1,000 patients compared with post-discharge initiation and 116 fewer compared with enalapril continuation.
- Healthcare perspective analyses demonstrated annual per-patient savings of $452 versus enalapril and $811 versus delayed outpatient initiation, yielding an incremental cost-effectiveness ratio of $21,532 per quality-adjusted life-year.
- Budget impact projections showed cumulative cost savings of $449 per patient at 1 year and $2,550 per patient over 5 years compared with enalapril.
Structured PICO
Does inpatient initiation of sacubitril-valsartan improve cost-effectiveness and reduce hospitalizations compared with enalapril or delayed initiation in patients with HFrEF?
P
Population
Modeled US patients with HFrEF eligible for sacubitril-valsartan treatment, with a mean age of 63.8 years, evaluated over a lifetime horizon.
I
Intervention
Inpatient initiation of sacubitril-valsartan
C
Comparator
Continuation of enalapril, no initiation of sacubitril-valsartan, or posthospitalization initiation of sacubitril-valsartan
O
Outcome
Cost-effectiveness (incremental cost-effectiveness ratio per quality-adjusted life-year) and cost savings
Main Result
Effect estimate: ICER $21,532 per QALY
Inpatient initiation of sacubitril-valsartan in HFrEF patients is cost-effective and reduces hospitalizations compared to delayed initiation or enalapril continuation.
Cite This Study
Gaziano et al. (2020) studied Heart failure with reduced ejection fraction (HFrEF). Sacubitril-valsartan (inpatient initiation) vs. Continuation of enalapril or posthospitalization initiation of sacubitril-valsartan was evaluated on Cost-effectiveness (incremental cost-effectiveness ratio) (ICER $21,532 per QALY). Inpatient initiation of sacubitril-valsartan in HFrEF patients was associated with 116 fewer HF admissions per 1000 patients and an ICER of $21,532 per QALY compared with continued enalapril.