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Health care delivery, economics and global health care
Original research article
Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction
  1. John J V McMurray1,
  2. David Trueman2,3,
  3. Elizabeth Hancock2,3,
  4. Martin R Cowie4,
  5. Andrew Briggs5,
  6. Matthew Taylor6,
  7. Juliet Mumby-Croft2,
  8. Fionn Woodcock2,
  9. Michael Lacey7,
  10. Rola Haroun8,
  11. Celine Deschaseaux8
  1. 1 British Heart Foundation (BHF) Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2 Health Economics, DRG Abacus Ltd, Bicester, UK
  3. 3 Health Economics, PHMR Ltd, London, UK
  4. 4 National Heart and Lung Institute, Imperial College London, London, UK
  5. 5 Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
  6. 6 York Health Economics Consortium Ltd, University of York, York, UK
  7. 7 Global Economic Value & Market Access Life Sciences, IBM Watson Health, Cambridge, MA, USA
  8. 8 Cardio Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
  1. Correspondence to Rola Haroun, Novartis Pharma AG, Postfach, CH-4002 Basel, Switzerland; Rola.Haroun{at}novartis.com

Abstract

Objective Chronic heart failure with reduced ejection fraction (HF-REF) represents a major public health issue and is associated with considerable morbidity and mortality. We evaluated the cost-effectiveness of sacubitril/valsartan (formerly LCZ696) compared with an ACE inhibitor (ACEI) (enalapril) in the treatment of HF-REF from the perspective of healthcare providers in the UK, Denmark and Colombia.

Methods A cost-utility analysis was performed based on data from a multinational, Phase III randomised controlled trial. A decision-analytic model was developed based on a series of regression models, which extrapolated health-related quality of life, hospitalisation rates and survival over a lifetime horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER).

Results In the UK, the cost per quality-adjusted life-year (QALY) gained for sacubitril/valsartan (using cardiovascular mortality) was £17 100 (€20 400) versus enalapril. In Denmark, the ICER for sacubitril/valsartan was Kr 174 000 (€22 600). In Colombia, the ICER was COP$39.5 million (€11 200) per QALY gained. Deterministic sensitivity analysis showed that results were most sensitive to the extrapolation of mortality, duration of treatment effect and time horizon, but were robust to other structural changes, with most scenarios associated with ICERs below the willingness-to-pay threshold for all three country settings. Probabilistic sensitivity analysis suggested the probability that sacubitril/valsartan was cost-effective at conventional willingness-to-pay thresholds was 68%–94% in the UK, 84% in Denmark and 95% in Colombia.

Conclusions Our analysis suggests that, in all three countries, sacubitril/valsartan is likely to be cost-effective compared with an ACEI (the current standard of care) in patients with HF-REF.

  • heart failure with reduced ejection fraction
  • health care economics
  • quality and outcomes of care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2016-310661

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    Footnotes

    • Contributors JJVM, DT, EH, MRC, AB, MT, JMC, RH and CD contributed to the design of the evaluations. DT, EH, FW and ML were responsible for data collection, development of the economic model and performing the analysis. CD and RH were responsible for overseeing the content. All authors contributed to the writing of the manuscript.

    • Funding This analysis and the PARADIGM-HF study were funded by Novartis AG.

    • Competing interests CD and RH are permanent employees of Novartis AG. CD and RH oversaw the all stages of the economic evaluation and contributed to the design and reporting of the economic model. DRG Abacus received funding from Novartis AG to undertake the analysis and has supported EH, DT JJVM and FW through salary payments. York Health Economics Consortium received funding from Novartis AG to provide consulting input and has supported MT through salary payments. MRC and AB have received consulting fees from Novartis AG. JJVM’s employer, Glasgow University, has received consulting fees and research grant support from Novartis AG.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice Since this paper has been published online an update has been made to the paragraph Colombian setting. The ICER value of €15 975 has been changed to € 11 200.