PMID- 27571284
OWN - NLM
STAT- MEDLINE
DCOM- 20170427
LR  - 20220408
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Linking)
VI  - 165
IP  - 10
DP  - 2016 Nov 15
TI  - Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With 
      Reduced Ejection Fraction.
PG  - 681-689
LID - 10.7326/M16-0057 [doi]
AB  - BACKGROUND: Sacubitril-valsartan therapy reduces cardiovascular mortality 
      compared with enalapril therapy in patients with heart failure with reduced 
      ejection fraction. OBJECTIVE: To evaluate the cost-effectiveness of 
      sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in 
      patients with chronic heart failure. DESIGN: Markov decision model. DATA SOURCES: 
      Clinical trials, observational analyses, reimbursement data from the Centers for 
      Medicare & Medicaid Services, drug pricing databases, and Centers for Disease 
      Control and Prevention life tables. TARGET POPULATION: Patients at an average age 
      of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and 
      left ventricular ejection fraction of 0.40 or less. TIME HORIZON: Lifetime. 
      PERSPECTIVE: Societal. INTERVENTION: Treatment with sacubitril-valsartan or 
      lisinopril. OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), 
      costs, heart failure hospitalizations, and incremental cost-effectiveness ratios. 
      RESULTS OF BASE-CASE ANALYSIS: The sacubitril-valsartan group experienced 0.08 
      fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional 
      QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of 
      $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II 
      heart failure and $58 194 in those with class III or IV heart failure. RESULTS OF 
      SENSITIVITY ANALYSIS: Sacubitril-valsartan treatment was most sensitive to the 
      duration of improved outcomes, with a cost per QALY gained of $120 623 if the 
      duration was limited to the length of the trial (median, 27 months). No 
      variations in other parameters caused the cost to exceed $100 000 per QALY 
      gained. LIMITATION: The benefit of sacubitril-valsartan is based on a single 
      clinical trial. CONCLUSION: Treatment with sacubitril-valsartan provides 
      reasonable value in reducing cardiovascular mortality and morbidity in patients 
      with NYHA class II to IV heart failure. PRIMARY FUNDING SOURCE: U.S. Department 
      of Veterans Affairs and Institute for Clinical and Economic Review.
FAU - Sandhu, Alexander T
AU  - Sandhu AT
AD  - From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center 
      for Health Policy and Center for Primary Care and Outcomes Research, Stanford 
      University, and Stanford University School of Medicine, Stanford, California; and 
      Institute for Clinical and Economic Review, Boston, Massachusetts.
FAU - Ollendorf, Daniel A
AU  - Ollendorf DA
AD  - From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center 
      for Health Policy and Center for Primary Care and Outcomes Research, Stanford 
      University, and Stanford University School of Medicine, Stanford, California; and 
      Institute for Clinical and Economic Review, Boston, Massachusetts.
FAU - Chapman, Richard H
AU  - Chapman RH
AD  - From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center 
      for Health Policy and Center for Primary Care and Outcomes Research, Stanford 
      University, and Stanford University School of Medicine, Stanford, California; and 
      Institute for Clinical and Economic Review, Boston, Massachusetts.
FAU - Pearson, Steven D
AU  - Pearson SD
AD  - From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center 
      for Health Policy and Center for Primary Care and Outcomes Research, Stanford 
      University, and Stanford University School of Medicine, Stanford, California; and 
      Institute for Clinical and Economic Review, Boston, Massachusetts.
FAU - Heidenreich, Paul A
AU  - Heidenreich PA
AD  - From Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center 
      for Health Policy and Center for Primary Care and Outcomes Research, Stanford 
      University, and Stanford University School of Medicine, Stanford, California; and 
      Institute for Clinical and Economic Review, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
DEP - 20160830
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
RN  - 0 (Aminobutyrates)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Drug Combinations)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - E7199S1YWR (Lisinopril)
RN  - WB8FT61183 (sacubitril and valsartan sodium hydrate drug combination)
SB  - IM
CIN - Ann Intern Med. 2016 Nov 15;165(10 ):735-736. PMID: 27571568
CIN - Ann Intern Med. 2017 Apr 18;166(8):607-608. PMID: 28418550
CIN - Ann Intern Med. 2017 Apr 18;166(8):606-607. PMID: 28418551
MH  - Aminobutyrates/adverse effects/*economics/*therapeutic use
MH  - Angioedema/chemically induced
MH  - Angiotensin-Converting Enzyme Inhibitors/adverse effects/*economics/*therapeutic 
      use
MH  - Biphenyl Compounds
MH  - Cost-Benefit Analysis
MH  - Drug Combinations
MH  - Heart Failure/*drug therapy/mortality/physiopathology
MH  - Hospitalization/economics
MH  - Humans
MH  - Lisinopril/therapeutic use
MH  - Markov Chains
MH  - Middle Aged
MH  - Quality-Adjusted Life Years
MH  - Stroke Volume/physiology
MH  - Tetrazoles/adverse effects/*economics/*therapeutic use
MH  - Treatment Outcome
MH  - Valsartan
EDAT- 2016/08/30 06:00
MHDA- 2017/04/28 06:00
CRDT- 2016/08/30 06:00
PHST- 2016/08/30 06:00 [pubmed]
PHST- 2017/04/28 06:00 [medline]
PHST- 2016/08/30 06:00 [entrez]
AID - 2546543 [pii]
AID - 10.7326/M16-0057 [doi]
PST - ppublish
SO  - Ann Intern Med. 2016 Nov 15;165(10):681-689. doi: 10.7326/M16-0057. Epub 2016 Aug 
      30.