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Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand

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Abstract

Background

Sacubitril-valsartan is a new medication that has recently been recommended as a replacement for enalapril in the treatment of patients with heart failure with reduced ejection fraction (HFrEF).

Objective

This study aimed to determine the cost effectiveness of sacubitril-valsartan compared with enalapril.

Methods

An analytical decision model was developed to estimate the long-term costs and outcomes from a healthcare perspective. Clinical inputs were mostly derived from the PARADIGM-HF study. Enalapril-related costs, risk of non-cardiovascular death, and all-cause readmission rate were based on data from Thailand. The costs and outcomes were discounted at 3% annually. The incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2017. A series of sensitivity analyses were also performed.

Results

For the base-case, the increased cost (144,146 vs. 16,048 Thai baht [THB]) of sacubitril-valsartan was associated with gains in both life-years (9.214 vs. 8.367 years) and quality-adjusted life-years (QALYs) (7.698 vs. 6.909) compared with enalapril, yielding an ICER of 162,276 THB/QALY ($US4857.11/QALY). This ICER is not considered to be cost effective at the willingness-to-pay (WTP) level of 160,000 THB/QALY. The risk of cardiovascular death and costs of both sacubitril-valsartan and hospitalization influenced the ICER. At a WTP of 160,000 THB/QALY, sacubitril-valsartan had a 48% probability of being a cost-effective treatment.

Conclusions

At its current price in Thailand, sacubitril-valsartan may not represent good value for the nations’s limited healthcare resources. The cost of sacubitril-valsartan needs to reduce by approximately 2% to yield an ICER below the threshold.

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Acknowledgements

The authors gratefully acknowledge Ahthit Yindeengam for the technical assistance.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Rungroj Krittayaphong

  2. Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand

    Unchalee Permsuwan

Authors
  1. Rungroj Krittayaphong
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Contributions

RK: research design, data acquisition and interpretation, drafting and critical revision of the manuscript. UP: data acquisition, model development and analysis, interpretation of results, drafting and critical revision of the manuscript.

Corresponding author

Correspondence to Unchalee Permsuwan.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Rungroj Krittayaphong and Unchalee Permsuwan have no conflicts of interest that are directly relevant to the content of this study.

Ethical approval

This project did not involve the study of human subjects or animals.

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Krittayaphong, R., Permsuwan, U. Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand. Am J Cardiovasc Drugs 18, 405–413 (2018). https://doi.org/10.1007/s40256-018-0288-x

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  • DOI: https://doi.org/10.1007/s40256-018-0288-x

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