Lower Hospitalization and Total Healthcare Costs Among Patients with Heart Failure When Treated with Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker: A Retrospective Study of Managed Care Claims

Abstract

Background In the PARADIGM-HF trial, sacubitril/valsartan (SAC/VAL) was superior to enalapril in reducing risks of cardiovascular death and heart failure (HF) hospitalization in patients with HF and reduced ejection fraction (HFrEF); however, there is limited knowledge of the impact of SAC/VAL on real-world clinical outcomes and costs compared to angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB). Objective To compare hospitalization and healthcar e costs among patients with HFrEF treated with SAC/VAL vs. ACEI/ARB. Methods De-identified claims data of adults in a large US managed care health plan (commercial and Medicare Advantage [MA]) were used from Oct 2014 to Sep 2016. Stable patients were identified with claims-based proxy for HFrEF and >=1 claim for SAC/VAL (identified first), ACEI or ARB during Oct 2015 to Jun 2016. Index therapy with >=80% proportion of days covered for first 3 months was required. SAC/VAL and ACEI/ARB cohorts were matched for demographics, baseline characteristics and length of follow-up using propensity scores. Per-patient-per-month (PPPM) hospitalization and healthcare costs (health plan + patient paid amounts) were calculated during a variable follow-up period (3-12 months). Robust variance estimation was used to compare hospitalization and healthcare costs between matched cohorts. Results Post-match, 279 patients/cohort were identified (mean [SD] age, 67.9 [12.6] years; 73.5% MA enrollee; 68.1% male; 90.9% hypertension; 56.1% diabetes; 46.1% atrial fibrillation; mean (SD) follow-up, 185.0 [70.1] days). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, experienced lower mean (SD) PPPM HF hospitalizations (0.01 [0.06] vs. 0.03 [0.10], p=.003) and all-cause hospitalizations (0.05 [0.11] vs. 0.11 [0.20], p Conclusions Compared to ACEI/ARB-treated patients, patients initiated with SAC/VAL within the first year of US market approval experienced fewer monthly hospitalizations, which may have been associated with lower medical costs. Reduced monthly medical costs among patients initiated with SAC/VAL offset increased outpatient pharmacy costs, resulting in lower total healthcare costs. This study was supported by Novartis Pharmaceuticals Corporation.