title: Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction.
abstract: 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.
  
  
  METHODS
  Markov decision model.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  Treatment with sacubitril-valsartan or lisinopril.
  
  
  METHODS
  Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  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
  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.
  
  
  CONCLUSIONS
  The benefit of sacubitril-valsartan is based on a single clinical trial.
  
  
  CONCLUSIONS
  Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure.
  
  
  BACKGROUND
  U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.
authors: 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.
authors: Alexander T
authors: AT
authors: Sandhu
authors: 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.
authors: Daniel A
authors: DA
authors: Ollendorf
authors: 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.
authors: Richard H
authors: RH
authors: Chapman
authors: 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.
authors: Steven D
authors: SD
authors: Pearson
authors: 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.
authors: Paul A
authors: PA
authors: Heidenreich
mesh_terms: D000613:Aminobutyrates / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000799:Angioedema / Q000139:chemically induced; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000191:economics; D006801:Humans; D017706:Lisinopril / Q000627:therapeutic use; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013318:Stroke Volume / Q000502:physiology; D013777:Tetrazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D000806:Angiotensin-Converting Enzyme Inhibitors; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D000068756:Valsartan; D017706:Lisinopril; C549068:sacubitril and valsartan sodium hydrate drug combination