PMID- 29601093
OWN - NLM
STAT- MEDLINE
DCOM- 20190307
LR  - 20211204
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 38
IP  - 5
DP  - 2018 May
TI  - Cost-Effectiveness Analysis of Sacubitril/Valsartan for the Treatment of Heart 
      Failure with Reduced Ejection Fraction in the United States.
PG  - 520-530
LID - 10.1002/phar.2108 [doi]
AB  - OBJECTIVE: Sacubitril/valsartan (SAC/VAL) has been shown to reduce mortality and 
      hospitalization in patients with heart failure with reduced ejection fraction 
      (HFrEF) compared with enalapril but at a substantially higher cost. This study 
      evaluates the cost-effectiveness of SAC/VAL versus enalapril in patients with 
      HFrEF over a 5-year time horizon from the U.S. payer perspective. METHODS: A 
      cohort-based Markov model was developed to compare costs and quality-adjusted 
      life years (QALYs) between SAC/VAL and enalapril in patients with HFrEF over a 
      5-year time horizon. Markov states included New York Heart Association (NYHA) 
      class (II-IV) and death. Treatment discontinuation, HF-related hospitalizations, 
      and NYHA class progression were modeled as transition states based on data from 
      the PARADIGM trial. Other probabilities, costs, and utilities were obtained from 
      published literature and public databases. RESULTS: In the base case analysis, 
      SAC/VAL cost more than enalapril ($81,943 vs $67,287) and was more effective 
      (2.647 QALYs vs 2.546 QALYs), resulting in an incremental cost-effectiveness 
      ratio of $143,891/QALY gained. At a willingness to pay (WTP) of $100,000/QALY, 
      SAC/VAL was cost-effective up to a cost of $298/month. Results were most 
      sensitive to SAC/VAL cost, SAC/VAL mortality benefit, and NYHA progression 
      probability. SAC/VAL had a 10% and 52% probability of being cost-effective at WTP 
      thresholds of $100,000/QALY and $150,000/QALY, respectively. CONCLUSIONS: SAC/VAL 
      is associated with clinical benefit and may be cost-effective compared with the 
      current standard of care over realistic treatment durations from the payer 
      perspective. Results of this analysis can inform discussions on the value and 
      position of SAC/VAL in the current market.
CI  - (c) 2018 Pharmacotherapy Publications, Inc.
FAU - Zueger, Patrick M
AU  - Zueger PM
AD  - Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, 
      University of Illinois at Chicago, Chicago, Illinois.
FAU - Kumar, Varun M
AU  - Kumar VM
AD  - Institute for Clinical and Economic Review, Boston, Massachusetts.
FAU - Harrington, Rachel L
AU  - Harrington RL
AD  - Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, 
      University of Illinois at Chicago, Chicago, Illinois.
FAU - Rigoni, Gianna C
AU  - Rigoni GC
AD  - Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, 
      University of Illinois at Chicago, Chicago, Illinois.
FAU - Atwood, Alicia
AU  - Atwood A
AD  - Economics Department, University of Illinois at Chicago, Chicago, Illinois.
FAU - DiDomenico, Robert J
AU  - DiDomenico RJ
AD  - Department of Pharmacy Practice, College of Pharmacy, University of Illinois at 
      Chicago, Chicago, Illinois.
AD  - Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of 
      Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
FAU - Touchette, Daniel R
AU  - Touchette DR
AUID- ORCID: 0000-0003-1972-8934
AD  - Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, 
      University of Illinois at Chicago, Chicago, Illinois.
AD  - Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of 
      Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20180425
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Aminobutyrates)
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Drug Combinations)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - WB8FT61183 (sacubitril and valsartan sodium hydrate drug combination)
SB  - IM
MH  - Aminobutyrates/economics/*therapeutic use
MH  - Angiotensin Receptor Antagonists/economics/*therapeutic use
MH  - Biphenyl Compounds
MH  - Cohort Studies
MH  - Cost-Benefit Analysis
MH  - Drug Combinations
MH  - Drug Costs
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Hospitalization/economics/statistics & numerical data
MH  - Humans
MH  - Markov Chains
MH  - *Quality-Adjusted Life Years
MH  - Stroke Volume
MH  - Tetrazoles/economics/*therapeutic use
MH  - Valsartan
OTO - NOTNLM
OT  - cost-effectiveness
OT  - heart failure with reduced ejection fraction
OT  - quality-adjusted life year
OT  - sacubitril-valsartan
EDAT- 2018/03/31 06:00
MHDA- 2019/03/08 06:00
CRDT- 2018/03/31 06:00
PHST- 2018/03/31 06:00 [pubmed]
PHST- 2019/03/08 06:00 [medline]
PHST- 2018/03/31 06:00 [entrez]
AID - 10.1002/phar.2108 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2018 May;38(5):520-530. doi: 10.1002/phar.2108. Epub 2018 Apr 
      25.