Background
The cost-effectiveness, from the Australian health care perspective, of switching
patients with heart failure and reduced ejection fraction (HFREF) stable on angiotensin
converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) to the
angiotensin receptor neprilysin inhibitor (ARNi) sacubitril/valsartan is unclear.
We sought to assess the cost-effectiveness of sacubitril/valsartan versus enalapril
in patients with HFREF in the contemporary Australian setting.
Methods
We developed a Markov model with two health states (‘Alive’ and ‘Dead’) to assess
the cost-effectiveness of sacubitril/valsartan versus enalapril in patients with HFREF.
Model subjects were 63 years of age at entry and had simulated follow-up over 20 years.
Transition probabilities were derived from the Prospective comparison of ARNI with
ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF)
study. Costs and utility data were derived from published sources. All costs and effects
were discounted at an annual rate of 5% and are presented in Australian dollars. Sensitivity
analyses were undertaken to test variability in key data inputs.
Results
In the base-case analysis, sacubitril/valsartan was found to reduce non-fatal heart
failure hospitalisations and cardiovascular deaths, with numbers-needed-to-treat over
a 20-year period of 40 and 27, respectively. The use of sacubitril/valsartan led to
an additional 6 months of life gained per patient, translating to A$27,954 per years
of life saved (YoLS) and A$40,513 per quality-adjusted-life-years (QALY) gained. The
results of the sensitivity analyses indicated that the results were robust.
Conclusions
Our analysis supports switching HFREF patients on ACE inhibitor or ARB to sacubitril/valsartan.
Keywords
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Article info
Publication history
Published online: March 28, 2019
Accepted:
March 16,
2019
Received in revised form:
January 19,
2019
Received:
July 11,
2018
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
