Sacubitril/Valsartan Has Possible Economic Benefit When Administered in a Hospital Setting to Patients With HFrEF

A recent study on sacubitril/valsartan use among patients with heart failure with reduced ejection fraction (HFrEF) produced results showing an economic benefit when the combination treatment is administered in the hospital setting, reported the findings in JAMA Cardiology. This finding was seen following a comparison with the combination treatment’s administration post hospitalization or when it was not administered at all, as well as vs treatment with enalapril.

Also known as systolic heart failure, HFrEF is the condition in which the left ventricle of the heart can only pump out 40% or less of the blood it contains with each contraction, resulting in less oxygen-rich blood being disseminated to the body than it actually needs.

“Hospitalization, long-term care, and medication costs for sacubitril/valsartan and enalapril were modeled with a discount rate of 3%,” the study authors explained. “The base-case analysis included a lifetime horizon from a health care and societal perspective.”

The PARADIGM-HF trial has already demonstrated the safety and efficacy of sacubitril/valsartan, and PIONEER-HF evaluated the economic impact but only in the outpatient setting. These 2 studies were used to develop a 5-state Markov model simulating HF for the present study.

Quality of life was also investigated in the present study via the Euro-QoL EQ-5D score in the economic evaluation study of US patients with HFrEF who qualified for treatment with sacubitril/valsartan between December 8, 2009, and May 15, 2018. Their mean (SD) age was 63.8 (11.5) years. Per the American Heart Association, “approximately 367,000 patients with heart failure are eligible for sacubitril/valsartan treatment each year.”

From a health care perspective, inpatient administration of sacubitril/valsartan, which totaled $5628 per year, produced economic benefits on several fronts:

• $452 savings per year compared with enalapril treatment
• $811 savings per year vs initiating the treatment 2 months post hospitalization
• $21,532 lifetime incremental cost-effectiveness ratio compared with enalapril treatment

Investigation regarding the societal perspective, which included the health care perspective plus productivity gains (due to a longer life and increased consumption), also showed economic benefit from inpatient administration of sacubitril/valsartan:

• $460 savings per year per patient (PPPY) vs not initiating the combo
• $813 savings PPPY vs initiating the treatment 2 months post hospitalization
• $1000 to $1500 PPPY in productivity gains

An additional budget analysis exhibited estimated individual yearly savings of $449 with sacubitril/valsartan and 5-year savings of $2550, both measures compared with enalapril treatment.

Lifetime HF-related admissions also fell on 2 fronts, per 1000 patients: inpatient vs outpatient administration of sacubitril/valsartan and the combo vs enalapril:

• Inpatient vs outpatient administration: 62 fewer admissions
• Combo vs enalapril: 116 fewer admissions

And at 2 months post hospitalization, patients with HFrEF were predicted to have 44% fewer admissions over a lifetime if sacubitril/valsartan was administered during their stay vs enalapril.

“We found that for eligible patients with HFrEF, initiation of sacubitril/valsartan during hospitalization was cost saving compared with initiation 2 months after hospitalization,” the authors concluded, “and was cost saving or highly cost-effective compared with indefinite continuation of enalapril treatment.”

Reference

Gaziano TA, Fonarow GC, Velazquez EJ, et al. Cost-effectiveness of sacubitril-valsartan in hospitalized patients who have heart failure with reduced ejection fraction. JAMA Cardiol. Published online August 12, 2020. doi:10.1001/jamacardio.2020.2822