Cost-Effectiveness Of Sacubitril/Valsartan (Formerly Lcz696) In Chronic Heart Failure Patients With Reduced Ejection Fraction - An Analysis For Switzerland

We assessed the cost-effectiveness of sacubitril/valsartan compared to angiotensin-converting enzyme inhibitors for the treatment of individuals with chronic heart failure (CHF) and reduced ejection fraction (HFrEF), from the Swiss healthcare system perspective. The model was implemented as a lifelong regression-based cohort-model comparing sacubitril/valsartan with enalapril in CHF patients with HFrEF and New York Heart Association Functional Classification II-IV symptoms. Regression models based on the randomised, clinical, phase III PARADIGM-HF trial were used to predict events (all-cause mortality, hospitalisations, adverse events and quality-of-life) for each treatment strategy over the modelled life-time horizon, adjusted for patient characteristics. Alternative analyses were implemented (cardiovascular mortality based on PARADIGM-HF trial, non-cardiovascular mortality obtained from Swiss life-tables). Costs data were obtained from Swiss sources for year 2014. Costs and effects were discounted by 3%. The outcome of interest was incremental cost-effectiveness ratio (ICER), expressed as cost per quality adjusted life year (QALY) gained. Deterministic sensitivity analyses (DSA), scenario and probabilistic sensitivity analyses (PSA) established the robustness of the results. In the base-case analysis, the sacubitril/valsartan strategy compared to enalapril showed a decrease in number of hospitalisations (6.0%/year absolute reduction) and life-time hospital costs by 8.0% (discounted). Sacubitril/valsartan was predicted to improve overall and quality-adjusted survival by 0.50 years and 0.42 QALYs. Additional net total costs were CHF 16,204, leading to an ICER of CHF 38,091. Alternative use of Swiss life-tables led to an ICER of CHF 35,527. DSA showed that results were robust; there was sensitivity to long-term mortality assumptions, duration of treatment effect and time horizon. In PSA, the probability of sacubitril/valsartan being cost-effective at thresholds of CHF 40, 000 and CHF 50,000 was 82.0% and 96.0%. From the Swiss healthcare system perspective, treatment of HFrEF patients with sacubitril/valsartan versus enalapril is likely to be cost-effective, if willingness-to-pay threshold of CHF 50,000 per QALY-gained is assumed.