Budget Impact Analysis and Alternative Funding Solutions of Sacubitril/Valsartan for the Treatment of Heart Failure With Reduced Ejection Fraction in Thailand

Objective This study evaluated the budget impact of sacubitril/valsartan for treating heart failure with reduced ejection fraction compared with enalapril and assessed alternative funding mechanisms under decision uncertainty. Methods The study comprised 3 components. First, a decision tree and a Markov model were used to estimate the budget impact over a 5-year time horizon. The base-case adopted a payer perspective, including direct medical costs, whereas a scenario analysis incorporated direct non-medical and indirect costs. Second, a situation analysis identified key decision uncertainties. Third, an economic impact analysis evaluated alternative funding mechanisms relative to the current reimbursement system. Results In the base-case, the cumulative net budget impact was United States dollars (USD) 18.40 million. For the scenario analysis, the net economic impact decreased to USD 15.72 million, indicating a partial offset of the additional drug expenditure. The new treatment mix was estimated to avoid 300 heart failure hospitalizations and 146 cardiovascular deaths over 5 years. Key uncertainties included high budget requirements, limited epidemiological data, and variability in clinical outcomes. To address these, 2 funding mechanisms were explored: coverage with evidence development to reduce clinical uncertainty and a price-volume agreement with a capped budget to manage financial risk. Conclusion Sacubitril/valsartan increased total expenditure compared with the current treatment; however, savings from reduced hospitalizations and broader societal costs partially offset the additional drug cost. Sacubitril/valsartan may be a manageable option when implemented with coverage with evidence development and price-volume agreements, supporting financial sustainability and long-term health outcomes.