Abstract
Background: In a pooled analysis of the PARAGON-HF and PARAGLIDE-HF trials, sacubitril-valsartan was effective in the treatment of heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) in patients who experienced a recent worsening heart failure event. Research Question: The cost-effectiveness of sacubitril-valsartan in this patient population has yet to be established. Aim: We performed a cost-effectiveness analysis of sacubitril-valsartan in patients with HFmrEF/HFpEF in patients with a recent worsening heart failure event. Methods: Using a 2-state Markov model, we simulated treatment with sacubitril-valsartan vs. placebo in populations of 1,000 patients with HFmrEF/HFpEF and a recent worsening heart failure event. Clinical event rates were based on 5-year data from the I-PRESERVE trial and calibrated to reproduce event rates observed in the pooled analysis of the PARAGON-HF and PARAGLIDE-HF trials. Based on a United States health care system perspective, outcome data from the trials were used to calculate incremental cost-effectiveness ratios. Results: Treatment with sacubitril-valsartan resulted in an increase of 0.88 and 0.53 life years and quality-adjusted life years, respectively, compared to placebo. Lifetime costs increased due to the cost of sacubitril-valsartan. The incremental cost-effectiveness ratio was $96,762 (Table 1). Conclusions: Use of sacubitril-valsartan in patients HFmrEF/HFpEF with a recent worsening heart failure event displayed intermediate value by American Heart Association/American College of Cardiology standards. This study supports the current guideline recommendation to consider sacubitril-valsartan in HFmrEF/HFpEF.
Published Version
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