Sacubitril–valsartan costs may be justified in NYHA class II-IV heart failure
medwireNews: Sacubitril–valsartan is cost-effective for the reduction of cardiovascular mortality and morbidity in patients with New York Heart Association (NYHA) class II to IV heart failure and reduced ejection fraction, US study findings indicate.
“The value of the treatment was greatest in class II patients, who had greater treatment benefit in the PARADIGM-HF trial”, Alexander Sandhu (Stanford University, California) and colleagues report.
They found that compared with the ACE inhibitor lisinopril, treatment with sacubitril–valsartan resulted in 0.08 fewer heart failure hospitalisations, 0.69 additional life–years, 0.62 additional quality-adjusted life–years (QALYs) and US$ 29,203 (€ 25,891) in incremental costs, which equated to a cost per QALY gained of $ 47,053 (€ 41,717).
This was based on a Markov model that included a cohort of patients with characteristics in line with those who participated in the PARADIGM-HF trial, including a mean age of 64 years, New York Heart Association (NYHA) class II to IV heart failure and a left ventricular ejection fraction of 0.40 or less.
At an average daily cost of $ 12.50 (€ 11.08), the cost per QALY gained with sacubitril–valsartan was $ 44,531 (€ 39,481) in patients with NYHA class II heart failure, increasing to $ 58,194 (€ 51,595) in those with class III or IV heart failure.
Of note, treatment with sacubitril–valsartan was associated with a 0.84-year reduction in survival compared with lisinopril in NYHA class I patients, but the cost was still $ 21,029 (€ 18,644) higher.
Sandhu et al say their findings are limited by the fact that they are based on efficacy data from a single trial, but point out that the “results were robust to sensitivity analyses that addressed concerns about treatment and support the adoption of sacubitril–valsartan therapy.”
The parameter that had the greatest effect on cost was the duration of improved outcomes, with a cost of $ 120,623 (€ 106,945) per QALY gained when the duration of improvement was limited to 27 months – the median follow-up period in PARADIGM-HF. For this figure to fall below $ 100,000 (€ 88,660), which represents intermediate value, the improved outcomes with sacubitril–valsartan would need to be sustained for at least 36 months, the authors observe.
However, changes in monthly cost, baseline and incremental utility value, and risk of hospitalisation and cardiovascular death did not cause the cost to exceed the intermediate value limit.
Sandhu and co-authors conclude in the Annals of Internal Medicine that the benefits of sacubitril–valsartan “may justify the increase in treatment costs, depending on the societal willingness to pay.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016