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Cost Effectiveness of the First‐in‐Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting

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Abstract

Objective

The aim of this study was to model the potential long-term disease progression and pharmacoeconomic value of sacubitril/valsartan for the treatment of essential hypertension from a Chinese healthcare system perspective.

Methods

A Markov cohort model with five health states was constructed to simulate the incidence of acute cardiovascular events and cost per quality-adjusted life-year (QALY) gained with sacubitril/valsartan compared with allisartan isoproxil and valsartan over a lifetime horizon with an annual cycle. Multivariable risk regression models derived from China-PAR data accompanied by hazard ratios were used to transform the dual mechanism of sacubitril/valsartan to lower blood pressure and left ventricular mass index into long-term fatal and non-fatal cardiovascular risks. Efficacy data were calculated using a network meta-analysis integrated by the results of clinical trials. Healthcare costs were determined from a real-world study and published literature, supplemented by expert opinion. Utilities were derived from literature. Both costs and health outcomes were discounted at 5.0% annually, and prices corresponded to 2021. Model validation, deterministic and probabilistic sensitivity analyses were conducted to test the robustness of results.

Results

For simulated patients with hypertension, sacubitril/valsartan reduced the rates of myocardial infarction by 6.67% and 6.39%, stroke by 9.38% and 8.98%, and heart failure hospitalization by 9.92% and 9.62% relative to allisartan isoproxil and valsartan, respectively. It was also associated with gains in life expectancy among hypertensive individuals of 0.362–0.382 years. Eventually, lifetime costs per patient were CN¥59,272 (US$9187) for sacubitril/valsartan, CN¥54,783 (US$8492) for allisartan isoproxil, and CN¥56,714 (US$8791) for valsartan; total QALYs were 11.38, 11.24, and 11.25, respectively. The incremental cost-effectiveness ratio was CN¥31,805/QALY (US$4930/QALY) compared with allisartan isoproxil, and CN¥19,247/QALY (US$2983/QALY) compared with valsartan, both of which are below the one time per-capita GDP of CN¥80,976/QALY (US$12,551/QALY) in China. Similar results were obtained in various extensive sensitivity analysis scenarios.

Conclusions

This was the first study to evaluate the cost effectiveness of sacubitril/valsartan in the treatment of hypertension. Sacubitril/valsartan compares favorably with allisartan isoproxil and valsartan in the Chinese setting, which is mainly due to its higher efficacy resulting in fewer cardiovascular events and ultimately less related mortality over time. The results could inform deliberations regarding reimbursement and access to this treatment in China and may provide reference for facilitating more reasonable and efficient allocation of limited resources in such low- and middle-income countries.

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Authors and Affiliations

  1. School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China

    Xinyue Dong, Xiaoning He & Jing Wu

  2. Center for Social Science Survey and Data, Tianjin University, Tianjin, China

    Xinyue Dong, Xiaoning He & Jing Wu

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Correspondence to Jing Wu.

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Funding

The design and conduct of this study were funded by Beijing Novartis Pharma Co., LTD.

Conflict of interest

Xinyue Dong, Xiaoning He, and Jing Wu declare that they have no conflicts of interest.

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All data generated or analyzed during this study are included in this published article and its supplementary information files. The raw data is available from the corresponding author upon reasonable request.

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The cost-effectiveness model was developed in Microsoft Excel 365 (Microsoft Corporation). Any additional information about model simulation programming is available from the corresponding author upon request.

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All authors contributed to study conception and design. Material preparation, data collection, and analysis were performed by Xinyue Dong, Xiaoning He, and Jing Wu. The first draft of the manuscript was written by Xinyue Dong and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Dong, X., He, X. & Wu, J. Cost Effectiveness of the First‐in‐Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting. PharmacoEconomics 40, 1187–1205 (2022). https://doi.org/10.1007/s40273-022-01182-2

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