Sacubitril-valsartan cost-effective for heart failure patients

By Will Boggs MD

NEW YORK (Reuters Health) - The novel combination of sacubitril and valsartan (Entresto, Novartis) is cost-effective for patients with NYHA class II to IV heart failure, according to results from a Markov decision model.

"We found that the treatment provides reasonable value under most assumptions despite the substantial increase in medication costs," Dr. Alexander T. Sandhu from Stanford University Center for Primary Care and Outcomes Research, Stanford, California told Reuters Health by email. "It is specifically interesting that the value is greater in NYHA Class II patients who are less symptomatic than NYHA Class III patients."

The PARADIGM-HF trial demonstrated reduced cardiovascular mortality, decreased hospitalizations and emergency department visits for heart failure, and improved quality of life with sacubitril-valsartan compared with enalapril therapy, but, at $12.50 per day, sacubitril-valsartan is substantially more expensive than generic ACE inhibitors that can cost less than 10 cents per day.

Dr. Sandhu and colleagues used a Markov decision model to compare the cost-effectiveness of sacubitril-valsartan, compared with usual care, in patients with heart failure based on data from the PARADIGM-HF trial.

Compared with usual care (treatment with lisinopril), sacubitril-valsartan provided an additional 0.62 quality-adjusted life-years (QALY) at an increased cost of $29,203, for an overall cost per QALY gained of $47,053.

The cost per additional QALY was lower in patients with NYHA class II heart failure ($44,531) than in patients with NYHA class III or IV heart failure ($58,194), according to the August 30th Annals of Internal Medicine report.

Among patients with NYHA class I heart failure, sacubitril-valsartan was associated with a decrease in average survival of 0.57 QALY at a cost increase of $21,029.

The cost of treatment would exceed $50,000 per QALY if the daily cost were to increase to $13.36 or higher, but the drug price would have to more than double (to $28.01) for the treatment to cost more than $100,000 per QALY.

The improved outcomes with sacubitril-valsartan would need to be sustained for at least 36 months for the cost per QALY to remain less than $100,000.

"It is important to remember that the clinical evidence basis for sacubitril-valsartan is limited to a single, albeit large, clinical trial," Dr. Sandhu cautioned. "Therefore, future estimates of clinical effectiveness may affect our understanding of the clinical and economic effects of sacubitril-valsartan therapy. It will be important to monitor the long-term outcomes of treated patients to rule out any increase in adverse events that would lower the expected effectiveness."

Two of the five authors, not including Dr. Sandhu, report having received "dues" from Novartis outside this study.

SOURCE: http://bit.ly/2c5o3IX

Ann Intern Med 2016.

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