Abstract 14302: Adoption of Sacubitril/Valsartan to Treat Acute Decompensated Heart Failure Improves Health System Finances Under Value-based Alternative Payment Models

Abstract

Introduction: The PIONEER-HF trial demonstrated superior efficacy of sacubitril/valsartan over the angiotensin-converting-enzyme inhibitor (ACEi) enalapril in treating patients with acute decompensated heart failure (ADHF) after stabilization in the inpatient setting, but how medication choice affects health system finances is unknown. Measuring the financial impact is complicated as health systems are increasingly reimbursed through value-based alternative payment models (APM). Methods: A decision tree model was used to assess the financial impact of health system adoption of sacubitril/valsartan to treat ADHF under APM reimbursement. The model estimated differences in health care utilization and cost when treating hospitalized ADHF patients with ACEi or angiotensin-receptor blockers compared to sacubitril/valsartan using efficacy results from PIONEER-HF. The financial impact on health systems was assessed across three common APMs: Medicare Shared Savings Program (MSSP), Bundled Payments for Care Improvement (BPCI), and fee-for-service payments adjusted via the Hospital Readmission Reduction Program (HRRP). Results: Sacubitril/valsartan reduced re-hospitalizations after an ADHF admission by 46.3% for individuals aged 18-64 years and 23.4% for individuals aged ≥65 years. Health system financial benefit from adopting sacubitril/valsartan was $740 per ADHF case per year (PCPY). Savings were larger for patients aged ≥65 years ($803 PCPY) compared to those <65 years ($653 PCPY). Adoption of sacubitril/valsartan improved health system finances under value-based APMs with the largest financial benefits under the HRRP ($1,190 financial gain PCPY), followed by BPCI ($645 financial gain PCPY) and MSSP ($253 financial gain PCPY). Conclusions: Adoption of sacubitril/valsartan to treat ADHF is expected to decrease hospitalizations and lead to a positive net financial impact on health systems under the commonly implemented APMs.