Why the study?
To review the cost-effectiveness of guideline-directed medical therapy for heart failure in India and identify drugs that can be made available free of cost or at subsidized rates.
Are Class I heart failure medications cost-effective for preventing cardiovascular mortality and heart failure re-hospitalization in India?
Are Class I heart failure medications cost-effective for preventing cardiovascular mortality and heart failure re-hospitalization in India?
In India, ARNi is not cost-effective for preventing cardiovascular mortality or heart failure re-hospitalization based on WHO thresholds, whereas most other Class I HF drugs are cost-effective for reducing re-hospitalizations.
Warrants restricting ARNi in India; challenges universal Class I HF recommendations without local cost adaptation.
Introduction: Our aim was to review the cost-effectiveness of guideline-directed medical therapy of heart failure in India and identify drugs that can be made available free of cost or at subsidized rates to the patient population. Methods: Data extracted from ten landmark trials in heart failure was used to compute the number needed to treat (NNT) and cost needed to treat (CNT) of drugs used in heart failure, to prevent cardiovascular mortality and heart failure re-hospitalization using the HDS Plotter-Incremental Cost Effectiveness Calculator. Since various brands (i.e., trade names) with a wide cost range are available in the Indian market, the average retail price in Indian Rupees for the year 2019 was used for the analysis. NNT and CNT of each drug were computed, and the cost-effectiveness was analyzed. The CNT of these drugs was compared with India's per capita Gross Domestic Product (GDP). The WHO recommendation of three times per capita GDP was used as the cost-effectiveness threshold. Results: Medications that were labeled as Class I for the treatment of heart failure were included in our analysis. Ivabradine, valsartan, and angiotensin receptor neprilysin inhibitor (ARNi) did not meet the cost-effectiveness criteria for preventing cardiovascular mortality. For the prevention of heart failure re-hospitalization, all drugs except ARNi met the cost-effectiveness threshold. Conclusion: Any future research would need to consider the compliance factor along with Willingness to Pay to understand the real acceptance of these drugs on the ground in India.
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George et al. (2020) studied this question.
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