title: Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction.
abstract: The objective of this study was to determine the cost-effectiveness and cost per quality-adjusted life year (QALY) gained of sacubitril-valsartan relative to enalapril for treatment of heart failure with reduced ejection fraction (HFrEF).
  
  
  
  Compared with enalapril, combination angiotensin receptor-neprilysin inhibition (ARNI), as is found in sacubitril-valsartan, reduces cardiovascular death and heart failure hospitalization rates in patients with HFrEF.
  
  
  
  Using a Markov model, costs, effects, and cost-effectiveness were estimated for sacubitril-valsartan and enalapril therapies for the treatment of HFrEF. Patients were 60 years of age at model entry and were modeled over a lifetime (40 years) from a third-party payer perspective. Clinical probabilities were derived predominantly from PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). All costs and effects were discounted at a 3% rate annually and are presented in 2015 U.S. dollars.
  
  
  
  In the base case, sacubitril-valsartan, compared with enalapril, was more costly ($60,391 vs. $21,758) and more effective (6.49 vs. 5.74 QALYs) over a lifetime. The cost-effectiveness of sacubitril-valsartan was highly dependent on duration of treatment, ranging from $249,411 per QALY at 3 years to $50,959 per QALY gained over a lifetime.
  
  
  
  Sacubitril-valsartan may be a cost-effective treatment option depending on the willingness-to-pay threshold. Future investigations should incorporate real-world evidence with sacubitril-valsartan to further inform decision making.
authors.affiliation: Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah. Electronic address: jordan.king@pharm.utah.edu.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: King
authors.affiliation: Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Rashmee U
authors.initials: RU
authors.lastname: Shah
authors.affiliation: Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Bress
authors.affiliation: Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah; Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah; SelectHealth, Salt Lake City, Utah.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Bellows
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000613:Aminobutyrates / Q000191:economics / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D002318:Cardiovascular Diseases / Q000401:mortality; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D004656:Enalapril / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015260:Neprilysin / Q000037:antagonists & inhibitors; D019057:Quality-Adjusted Life Years; D013318:Stroke Volume; D013777:Tetrazoles / Q000191:economics / Q000627:therapeutic use*; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D004656:Enalapril; D000068756:Valsartan; D015260:Neprilysin; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: LCZ696; angiotensin inhibition; cost utility; neprilysin inhibition