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Vericiguat for the Treatment of Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event: A Cost-Effectiveness Analysis from the Perspective of Chinese Healthcare Providers

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Abstract

Background and Objective

Approximately 38 million people worldwide experience heart failure (HF), with more than 10 million in China. Heart failure exacerbations are the main cause of HF hospitalization, and hospitalizations are the main driver of HF-associated costs. Vericiguat is recommended to treat patients who have had worsening HF despite guideline-directed medical therapy. However, the cost effectiveness of adding vericiguat to the standard treatment of this population in China remains unclear. The objective of this study was to investigate the cost effectiveness of adding vericiguat to standard treatment in patients with HF in the Chinese population

Methods

A lifetime Markov model with a 1-month cycle length was developed to compare the cost effectiveness of vericiguat plus standard treatment versus standard treatment alone in Chinese patients with HF with reduced ejection fraction following an HF exacerbation, from the perspective of Chinese healthcare providers. The clinical data were obtained from the VICTORIA study. The cost was accessed from our institution or studies conducted in China. The primary outcome was the incremental cost-effectiveness ratio, representing incremental cost per incremental quality-adjusted life-year (QALY). Vericiguat was considered highly cost effective if the incremental cost-effectiveness ratio obtained was lower than 12,551 USD/QALY, cost effective if the incremental cost-effectiveness ratio was between 12,551 and 37,654.5 USD/QALY, and not cost effective if the incremental cost-effectiveness ratio was higher than 37,654.5 USD/QALY. A scenario analysis, one-way sensitivity analysis, and probabilistic sensitivity analysis were performed to test the robustness of the results.

Results

For a 67-year-old patient with HF following an HF exacerbation, the lifetime cost was 17,721 USD if vericiguat plus standard treatment was given, compared to 7907 USD if standard treatment alone was prescribed. The corresponding effectiveness was 2.20 QALY and 2.10 QALY, respectively. The incremental cost-effectiveness ratio of vericiguat plus standard treatment versus standard treatment alone in Chinese patients with HF was 89,429 USD/QALY, higher than the willingness-to-pay threshold of 37654.5 USD/QALY. The scenario analysis and sensitivity analysis showed the robustness of our results.

Conclusions

The addition of vericiguat to the treatment regimen of Chinese patients with HF with reduced ejection fraction following an HF exacerbation resulted in an incremental cost-effectiveness ratio of $89,429 USD/QALY compared to standard treatment. This incremental cost-effectiveness ratio exceeds the willingness-to-pay threshold and thus, vericiguat was deemed not cost effective in the Chinese population.

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Author notes

  1. Xiangyou Yu and Yan Hao have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Cardiology, Shaanxi Provincial People’s Hospital, Youyi West Road, Xi’an, 710068, Shaanxi Province, People’s Republic of China

    Xiangyou Yu, Wei Zhang, Bo Liu, Meijuan Ma, Xuejun Zhang, Na Wei, Junkui Wang & Fuqiang Liu

  2. Department of Endocrinology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi Province, People’s Republic of China

    Xiangyou Yu

  3. Xi’an Jiaotong University Hospital, Xi’an, Shaanxi, People’s Republic of China

    Yan Hao & Zhanfang Zhu

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Correspondence to Fuqiang Liu.

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Funding

This study was supported by the Science and Technology Program of Xi’an [No. 21YXYJ0095], the Key Industrial Innovation Chain Project in Shaanxi Province of China [No. 2020ZDLSF01-08], the Shaanxi Provincial Health and Health Research Fund Project [No. 2022D024], the Natural Science Foundation of Shaanxi Province [No. 2022SF-476], and the Key Basic Natural Science Foundation of Shaanxi Province [No. 2022JZ-47].

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

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Author contributions

FL came up with the idea and designed the protocol. XY and YH synthesized the data and drafted the manuscript. YH developed the model. ZZ, WZ, BL, MM, XZ, NW, and JW participated in the data collection and data analysis. All authors approved the final version of the manuscript. XY and YH contributed equally to the manuscript and share the first authorship.

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Yu, X., Hao, Y., Zhu, Z. et al. Vericiguat for the Treatment of Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event: A Cost-Effectiveness Analysis from the Perspective of Chinese Healthcare Providers. Clin Drug Investig 43, 241–250 (2023). https://doi.org/10.1007/s40261-023-01253-y

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