PMID- 31101372
OWN - NLM
STAT- MEDLINE
DCOM- 20200518
LR  - 20211204
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 41
IP  - 6
DP  - 2019 Jun
TI  - Cost-Utility Analysis of Sacubitril/Valsartan Use Compared With Standard Care in 
      Chronic Heart Failure Patients With Reduced Ejection Fraction in South Korea.
PG  - 1066-1079
LID - S0149-2918(19)30198-5 [pii]
LID - 10.1016/j.clinthera.2019.04.031 [doi]
AB  - PURPOSE: Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin 
      inhibitor (ARNI), is a possible treatment option for chronic heart failure 
      patients with reduced ejection fraction (HFrEF). The aim of this study was to 
      estimate the cost-effectiveness of sacubitril/valsartan use in South Korea for 
      treating patients with HFrEF compared with that of enalapril, an 
      angiotensin-converting enzyme inhibitor, and with angiotensin receptor blockers 
      (ARBs). METHODS: A Markov model was designed to estimate the lifetime 
      cost-effectiveness of treatment for patients with HFrEF. Cohorts in the 
      alive-state incurred a monthly risk of hospitalization because of deteriorated 
      HF, adverse events (AEs), or death. Transition probabilities of 
      sacubitril/valsartan and enalapril were estimated by using data from the 
      PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on 
      Global Mortality and Morbidity in Heart Failure) trial. The effectiveness of ARBs 
      (eg, reduction in mortality and hospitalization rates) was assumed to be 
      identical to that of enalapril, according to the results of the meta-analysis. 
      However, there was no comparative evidence for AEs. We therefore conducted a 
      Bayesian network meta-analysis and adjusted the incidence rate of AEs for ARBs. 
      The utility for estimating quality-adjusted life years (QALYs) was elicited by 
      the survey of the general South Korean population by using EuroQol-5 dimensions. 
      We calculated the medical costs, including medication, monitoring, 
      hospitalization, AEs, and terminal care, from the health care sector perspective. 
      Costs and effectiveness were discounted by 5%. One-way sensitivity analyses and a 
      probabilistic sensitivity analysis were conducted to determine the model 
      robustness. FINDINGS: The total cost per patient for sacubitril/valsartan and 
      enalapril was $25,832 and $18,295, respectively. Sacubitril/valsartan was 
      associated with an  approximately 8- month longer life expectancy compared with enalapril and a 
      QALY gain of 0.59. As a result, the incremental cost-effectiveness ratio for 
      sacubitril/valsartan versus enalapril was $12,722 per QALY. The incremental 
      cost-effectiveness ratio of sacubitril/valsartan versus ARB was $11,970 with an 
      incurred cost of $18,741 for the ARB group. The main results and those of various 
      sensitivity analyses were lower than a threshold of $20,000. IMPLICATIONS: From a 
      health care sector perspective, sacubitril/valsartan is a cost-effective 
      treatment for HFrEF compared with enalapril and ARBs. This finding could be 
      helpful for cardiologists or decision makers in reaching cost-effective choices 
      regarding the treatment selection process.
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Park, Sun-Kyeong
AU  - Park SK
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
FAU - Hong, Sung-Hyun
AU  - Hong SH
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
FAU - Kim, HyoJin
AU  - Kim H
AD  - Patient Access, Novartis Korea, Ltd, Seoul, South Korea.
FAU - Kim, Sungju
AU  - Kim S
AD  - Patient Access, Novartis Korea, Ltd, Seoul, South Korea.
FAU - Lee, Eui-Kyung
AU  - Lee EK
AD  - School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea. 
      Electronic address: ekyung@skku.edu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20190515
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
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  - Chronic Disease
MH  - Cost-Benefit Analysis
MH  - Drug Combinations
MH  - Health Care Costs
MH  - *Heart Failure/drug therapy/economics/epidemiology/physiopathology
MH  - Humans
MH  - Models, Statistical
MH  - Republic of Korea
MH  - *Tetrazoles/economics/therapeutic use
MH  - Valsartan
MH  - Ventricular Dysfunction, Left
OTO - NOTNLM
OT  - Markov model
OT  - cost-effectiveness
OT  - heart failure
OT  - sacubitril/valsartan
EDAT- 2019/05/19 06:00
MHDA- 2020/05/19 06:00
CRDT- 2019/05/19 06:00
PHST- 2018/12/14 00:00 [received]
PHST- 2019/04/10 00:00 [revised]
PHST- 2019/04/17 00:00 [accepted]
PHST- 2019/05/19 06:00 [pubmed]
PHST- 2020/05/19 06:00 [medline]
PHST- 2019/05/19 06:00 [entrez]
AID - S0149-2918(19)30198-5 [pii]
AID - 10.1016/j.clinthera.2019.04.031 [doi]
PST - ppublish
SO  - Clin Ther. 2019 Jun;41(6):1066-1079. doi: 10.1016/j.clinthera.2019.04.031. Epub 
      2019 May 15.