title: An Economic Evaluation of Sacubitril/Valsartan for Heart Failure Patients in the Netherlands.
abstract: In September 2014, the PARADIGM-HF trial showed the heart failure drug combination sacubitril/valsartan to be superior to enalapril for patients with a reduced ejection fraction.
  
  
  
  To determine the incremental cost-effectiveness of sacubitril/valsartan compared with enalapril in the Netherlands using the clinical data from the PARADIGM-HF trial.
  
  
  
  To compare sacubitril/valsartan and enalapril in a cost-effectiveness study, a Markov model was developed using the effectiveness data from the PARADIGM-HF trial. A health care payer's perspective was applied in the economic evaluation. The developed model was used to evaluate the cost-effectiveness for sacubitril/valsartan at different per diem prices.
  
  
  
  The base-case analysis showed that sacubitril/valsartan can be cost-effective at maximum daily costs of €5.50 and €14.14 considering willingness-to-pay thresholds of €20,000 and €50,000 per quality-adjusted life-year (QALY), respectively. Sensitivity analysis demonstrated the robustness of the model, identifying only the price of sacubitril/valsartan and the mortality within the sacubitril/valsartan group as significant drivers of the cost-effectiveness ratio. Sacubitril/valsartan was cost-effective at a willingness-to-pay threshold of €20,000 per QALY (€50,000 per QALY) in more than 80% of the replications with certainty at the price point of €3 (€10).
  
  
  
  Sacubitril/valsartan can be considered a cost-effective treatment at a daily price of €5.25. Unless priced lower than enalapril (<€0.045 per day), sacubitril/valsartan is very unlikely to be cost-saving/dominant.
authors.affiliation: Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands. Electronic address: s.van.der.pol@student.rug.nl.
authors.forename: Simon
authors.initials: S
authors.lastname: van der Pol
authors.affiliation: Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Fabian
authors.initials: F
authors.lastname: Degener
authors.affiliation: Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands; Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
authors.forename: Pepijn
authors.initials: P
authors.lastname: Vemer
mesh_terms: D000613:Aminobutyrates / Q000191:economics* / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use; D001713:Biphenyl Compounds; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D005382:Financing, Personal; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D053208:Kaplan-Meier Estimate; D009426:Netherlands / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D013777:Tetrazoles / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D000068756:Valsartan; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: economic evaluation; heart failure; valsartan/sacubitril