Budget Impact Analysis of Sacubitril Valsartan in the Treatment of Heart Failure and Reduced Ejection Fraction (HFrEF) in Indonesia Setting

Abstract

Based on PARADIGM-HF Clinical Trials, LCZ696 a dual-acting sodium supramolecular complex currently known as sacubitril/valsartan was superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF) in patients with heart failure and reduced ejection fraction (HFrEF). This analysis aimed to estimate the budget impact of sacubitril/valsartan in the treatment of HFrEF in Indonesia setting. A budget impact model estimated the impact with and without use of sacubitril/valsartan for a 5-year horizon (2020 – 2024). The local data inputted in the model were including age prevalence rates, drugs costs, HF hospitalization cost, and adverse events costs. The drug cost calculation of sacubitril/valsartan was from regular price, while drugs costs of standard care were mostly coming from e-catalogue price which was reimbursement cost. The budget impact was estimated from the difference budget in which the target population is treated with the current therapy (without sacubitril/valsartan) and the future scenario in which the target population is treated with sacubitril/valsartan based on a market penetration rate of 6%, 12%, 18%, 24%, and 31% in the first, second, third, fourth and fifth years, respectively. Given the number of patients eligible for treatment was estimated as 86,594 in the first year and assumption of annual increase of HF prevalence was 1.1% based on population growth, about 1,350 deaths and 3,512 hospitalizations may be avoided over 5 years. The scenario of implementing sacubitril/valsartan for HF treatment had an impact of additional budget of 1%, 2%, 3%, 4%, 5% over 5-year horizon compared to current therapy strategy and cumulative budget impact as IDR 735 Billion over 5 years. This analysis provides an estimation of the impact of sacubitril/valsartan application in the treatment of patients with HF and reduced ejection fraction as input for Indonesia healthcare payer in implementing the strategy for HF treatment.