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.

Keywords

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