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

Abstract

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.