PT  - JOURNAL ARTICLE
AU  - John J V McMurray
AU  - David Trueman
AU  - Elizabeth Hancock
AU  - Martin R Cowie
AU  - Andrew Briggs
AU  - Matthew Taylor
AU  - Juliet Mumby-Croft
AU  - Fionn Woodcock
AU  - Michael Lacey
AU  - Rola Haroun
AU  - Celine Deschaseaux
TI  - Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction
AID  - 10.1136/heartjnl-2016-310661
DP  - 2018 Feb 08
TA  - Heart
PG  - heartjnl-2016-310661
4099  - http://heart.bmj.com/content/early/2018/02/08/heartjnl-2016-310661.short
4100  - http://heart.bmj.com/content/early/2018/02/08/heartjnl-2016-310661.full
AB  - 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.