Abstract 17655: Cost-effectiveness of Ivabradine as a Treatment for Systolic Chronic Heart Failure in the United States

Abstract

Introduction: To compare the long-term clinical, cost and quality of life outcome of ivabradine+ standard of care (SoC) versus SoC and assess the cost-effectiveness of ivabradine as a treatment to systolic chronic HF, a cost effectiveness model was developed from the perspective of US payers. Hypothesis: Ivabradine+SoC is a cost-effective treatment for systolic chronic HF compared to SoC in the US. Methods: A state-transition model was developed modeling the risk of death and HF-, non-HF CV-, and non-CV- related hospitalization and mortality over 10 years in a cohort of patients receiving ivabradine+SoC. As patients experienced more HF and non-HF CV hospitalizations in the model, they were subject to higher future risk of HF and non-HF CV hospitalization and lower quality of life. Hospitalization rates and costs by hospitalization type were taken from US claims data for patients in commercial and Medicare Advantage insurance plans. Mortality, utility inputs, and ivabradine treatment effect were derived from analyses of the pivotal randomized placebo-controlled SHIFT study. Both health and cost outcomes were discounted at 3% per year. One-way and multi-way sensitivity analyses were conducted. Results: In the commercially insured population based on a cost of $4,500 per year for ivabradine, the total costs over 10 years were $355,080 for a patient treated on ivabradine+SoC and $361,516 for a patient on SoC alone. The total lifetime drug cost of ivabradine ($27,201) was more than offset with cost-savings from reduction in hospitalization. Patients on ivabradine+SoC also had better health outcomes with an incremental improvement of 0.21 life-years and 0.24 quality-adjusted life years (QALYs) compared to SoC. Similar incremental health benefit was seen in the Medicare Advantage (0.20 QALYs) population, but the lower cost per hospitalization led to a modest increase in cost ($7,284). The incremental cost-effectiveness ratio was $36,944/QALY in the Medicare Advantage population. Conclusions: The results of this model indicate that ivabradine+SoC may be a less costly and more effective option compared to SoC in the commercial population and a cost-effective treatment option among Medicare Advantage patients.