Cost-Consequence Analysis of Sacubitril/Valsartan versus Enalapril in Chronic Heart Failure Patients with Reduced Ejection Fraction


  • Sameer Bhaskar GOKHALE Novartis Healthcare Private Limited
  • Saumitra RAY Professor, Vivekananda Institute of Medical Sciences, 99, Sarat Bose Rd, Kolkata, West Bengal 700026, India
  • Vijay Kumar CHOPRA Senior Director, Max Super Specialty Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, Saket, New Delhi - 110017, India
  • Uday JADHAV Consultant, Cardiology Department, MGM New Bombay Hospital, Sector 4, Vashi, New Mumbai, 400702, India
  • Gauri BILLA Franchise Medical Head, Medical Affairs, Novartis Healthcare Private Limited. Inspire BKC, ‘G’ Block, 6 & 7 Floor, BKC Main Road, Bandra Kurla Complex, Bandra East, Mumbai 400051, India


Enalapril, Costs and Cost Analysis (CCA), Heart Failure, Medical Economics, Sacubitril/valsartan


Purpose: The rising prevalence of heart failure (HF) in midlife years in Indians is posing an economic challenge. Sacubitril/valsartan demonstrated a significant risk reduction of cardiovascular deaths by 20% and HF rehospitalizations by 21% versus enalapril but has a higher drug cost. High cost is an impediment and poses a challenge for healthcare stakeholders to choose interventions that are more efficacious. We developed an intuitive evidence-based cost-consequence analysis (CCA) comparing sacubitril/valsartan with enalapril in chronic HF patients with reduced ejection fraction (HFrEF). Methods: Authors adopted HF outcome probabilities for mortality and hospitalizations from the PARADIGM-HF trial. Economic (drug acquisition and hospitalization costs, earning potential) and clinical [length of stay (LOS), rates of mortality and hospitalizations] inputs were obtained from the published literature. The tool enables the user to input patient numbers, health setting (public/private), time horizon (6-27 months), number of hospitalizations (1.42-5), LOS (5.3-9 days), and wages per day €5.61-€28.03 (INR500-INR2,500). Results: Hypothetical HF patient with a daily wages of €22.42 (INR 2,000) spent €420.31 (INR 37,490) for sacubitril/valsartan at a private set-up to realize an annual cost savings of €485.34 (INR 43,290). While  the other patient with a lower daily wage of €11.21, at a public set-up had to spend €43.09 (INR 3,843) more to realize benefits of mortality, hospitalization, and productivity savings due to sacubitril/valsartan. Conclusion: Sacubitril/valsartan has the potential to improve clinical as well as economic outcomes by generating substantial cost-savings to minimize budget deficit. CCA could support healthcare stakeholders in selecting an appropriate treatment strategy for chronic HFrEF patients.


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How to Cite

GOKHALE SB, RAY S, CHOPRA VK, JADHAV U, BILLA G. Cost-Consequence Analysis of Sacubitril/Valsartan versus Enalapril in Chronic Heart Failure Patients with Reduced Ejection Fraction. Appl Med Inform [Internet]. 2021 Jul. 4 [cited 2024 Mar. 3];43(2):81-90. Available from: