Cost-Effectiveness of Sacubitril/Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review
-
Aziz Rezapour
,
Samad Azari
,
Jalal Arabloo
,
Pirhossein Kolivand
,
Masoud Behzadifar
,
Negar Omidi
,
Ali Sarabi Asiabar
,
Peyman Saberian
,
Hamid Pourasghari
,
Nicola luigi Bragazzi
,
Mehdi Mehrani
,
Shayan Shahi
,
Masih Tajdini
Abstract
Background: To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF).
Methods: A systematic literature search was conducted searching in major electronic databases from inception to January 1, 2021. All relevant full economic evaluation studies of sacubitril/valsartan versus enalapril for the treatment of patients with HFrEF were identified using ad hoc search strategies. Mortality, hospital admissions, quality-adjusted life years (QALYs), life-years (LYQs), annual drug costs, total lifetime costs, and incremental cost-effectiveness ratio (ICER) were considered as the outcomes. The quality of the included studies was assessed using the CHEERS checklist. This study was conducted and reported in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines.
Results: The initial search yielded a pool of 1026 articles, of which 703 unique articles were screened, 65 full-text articles were assessed for eligibility and 15 studies finally included in the qualitative synthesis. Studies show that sacubitril/valsartan reduces mortality and hospitalization rate. The mean of death risk ratio and hospitalization were computed at 0.843 and 0.844, respectively. Sacubitril/valsartan produced higher annual and total lifetime costs. The lowest and highest lifetime costs for sacubitril/valsartan were found in Thailand ($4,756) and Germany ($118,815), respectively. The lowest ICER was reported in Thailand ($4857/QALY) and the highest in the USA ($143,891/QALY).
Conclusion: Sacubitril/valsartan is associated with better outcomes and may be cost-effective compared to enalapril for the management of HFrEF. However, in developing countries such as Thailand, sacubitril-valsartan costs must be reduced to yield an ICER below the threshold.
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3. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ; American Heart Association Advocacy Coor-dinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Car-diopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933-944.
4. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 2011;8:30-41.
5. Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJ. The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 2002;4:361-371.
6. Swedberg K, Kjekshus J. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). Am J Cardiol 1988;62:60A-66A.
7. SOLVD Investigators, Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. Effect of enalapril on survival in patients with re-duced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:293-302.
8. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014;371:993-1004.
9. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treat-ment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975.
10. Cristino J, Tang I, Ng C, Tan J, Trueman D, Lee D. RE: Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction. J Med Econ 2018;21:1145-1147.
11. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E; CHEERS Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Cost Eff Resour Alloc 2013;11:6.
12. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E; ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 2013;16:231-250.
13. Hiligsmann M, Evers SM, Ben Sedrine W, Kanis JA, Ramaekers B, Reginster JY, Silverman S, Wyers CE, Boonen A. A sys-tematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis. Pharmacoeconomics 2015;33:205-224.
14. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9, W64.
15. Gaziano TA, Fonarow GC, Claggett B, Chan WW, Deschaseaux-Voinet C, Turner SJ, Rouleau JL, Zile MR, McMurray JJ, Solomon SD. Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction. JAMA Cardiol 2016;1:666-672.
16. King JB, Shah RU, Bress AP, Nelson RE, Bellows BK. Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction. JACC Heart Fail 2016;4:392-402.
17. Zueger PM, Kumar VM, Harrington RL, Rigoni GC, Atwood A, DiDomenico RJ, Touchette DR. Cost-Effectiveness Analysis of Sacubitril/Valsartan for the Treatment of Heart Failure with Reduced Ejection Fraction in the United States. Pharmacother-apy 2018;38:520-530.
18. Gandjour A, Ostwald DA. Sacubitril/Valsartan (LCZ696): A Novel Treatment for Heart Failure and its Estimated Cost Effec-tiveness, Budget Impact, and Disease Burden Reduction in Germany. Pharmacoeconomics 2018;36:1285-1296.
19. van der Pol S, de Jong LA, Vemer P, Jansen DEMC, Postma MJ. Cost-Effectiveness of Sacubitril/Valsartan in Germany: An Application of the Efficiency Frontier. Value Health 2019;22:1119-1127.
20. van der Pol S, Degener F, Postma MJ, Vemer P. An Economic Evaluation of Sacubitril/Valsartan for Heart Failure Patients in the Netherlands. Value Health 2017;20:388-396.
21. Ramos IC, Versteegh MM, de Boer RA, Koenders JMA, Linssen GCM, Meeder JG, Rutten-van Mölken MPMH. Cost Effec-tiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch Phar-macoeconomic Guidelines. Value Health 2017;20:1260-1269.
22. Chin KL, Zomer E, Wang BH, Liew D. Cost-Effectiveness of Switching Patients With Heart Failure and Reduced Ejection Fraction to Sacubitril/Valsartan: The Australian Perspective. Heart Lung Circ 2020;29:1310-1317.
23. Perera K, Ademi Z, Liew D, Zomer E. Sacubitril-valsartan versus enalapril for acute decompensated heart failure: a cost-effectiveness analysis. Eur J Prev Cardiol 2021;28:966-972.
24. Liang L, Bin-Chia Wu D, Aziz MIA, Wong R, Sim D, Leong KTG, Wei YQ, Tan D, Ng K. Cost-effectiveness of sacubi-tril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction. J Med Econ 2018;21:174-181.
25. McMurray JJV, Trueman D, Hancock E, Cowie MR, Briggs A, Taylor M, Mumby-Croft J, Woodcock F, Lacey M, Haroun R, Deschaseaux C. Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction. Heart 2018;104:1006-1013.
26. Ademi Z, Pfeil AM, Hancock E, Trueman D, Haroun RH, Deschaseaux C, Schwenkglenks M. Cost-effectiveness of sacubi-tril/valsartan in chronic heart-failure patients with reduced ejection fraction. Swiss Med Wkly 2017;147:w14533.
27. Krittayaphong R, Permsuwan U. Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand. Am J Cardiovasc Drugs 2018;18:405-413.
28. Borges M, Afonso-Silva M, Laires PA, Gouveia M, Alarcão J, Ascenção R, Costa J. Cost-effectiveness of sacubitril/valsartan for the treatment of patients with heart failure with reduced ejection fraction in Portugal. Expert Rev Pharmacoecon Out-comes Res 2020;20:199-205.
29. Park SK, Hong SH, Kim H, Kim S, Lee EK. Cost-Utility Analysis of Sacubitril/Valsartan Use Compared With Standard Care in Chronic Heart Failure Patients With Reduced Ejection Fraction in South Korea. Clin Ther 2019;41:1066-1079.
30. Perera K, Ademi Z, Liew D, Zomer E. Sacubitril-valsartan versus enalapril for acute decompensated heart failure: a cost-effectiveness analysis. European journal of preventive cardiology. 2019:2047487319878953.
31. Consortium YHE. Incremental Cost-Effectiveness Ratio (ICER) UK2016. https://yhec.co.uk/glossary/incremental-cost-effectiveness-ratio-icer/(01 October 2022).
32. Consortium YHE. Cost-Effectiveness Threshold: York Health Economics Consortium; 2016 [Available from: https://yhec.co.uk/glossary/cost-effectiveness-threshold/. (01 October 2022).
33. Krittayaphong R, Permsuwan U. Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand. Am J Cardiovasc Drugs 2018;18:405-413.
34. Liu XQ, He LS, Huang JQ, Xiong LJ, Xia C, Lao HY. Cost-effectiveness analyses of sacubitril-valsartan for heart failure. Heart Fail Rev 2021;26:1119-1130.
2. Roger VL. Epidemiology of heart failure. Circ Res 2013;113:646-659.
3. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ; American Heart Association Advocacy Coor-dinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Car-diopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933-944.
4. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 2011;8:30-41.
5. Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJ. The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 2002;4:361-371.
6. Swedberg K, Kjekshus J. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). Am J Cardiol 1988;62:60A-66A.
7. SOLVD Investigators, Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. Effect of enalapril on survival in patients with re-duced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:293-302.
8. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014;371:993-1004.
9. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treat-ment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975.
10. Cristino J, Tang I, Ng C, Tan J, Trueman D, Lee D. RE: Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction. J Med Econ 2018;21:1145-1147.
11. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E; CHEERS Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Cost Eff Resour Alloc 2013;11:6.
12. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E; ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 2013;16:231-250.
13. Hiligsmann M, Evers SM, Ben Sedrine W, Kanis JA, Ramaekers B, Reginster JY, Silverman S, Wyers CE, Boonen A. A sys-tematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis. Pharmacoeconomics 2015;33:205-224.
14. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9, W64.
15. Gaziano TA, Fonarow GC, Claggett B, Chan WW, Deschaseaux-Voinet C, Turner SJ, Rouleau JL, Zile MR, McMurray JJ, Solomon SD. Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction. JAMA Cardiol 2016;1:666-672.
16. King JB, Shah RU, Bress AP, Nelson RE, Bellows BK. Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction. JACC Heart Fail 2016;4:392-402.
17. Zueger PM, Kumar VM, Harrington RL, Rigoni GC, Atwood A, DiDomenico RJ, Touchette DR. Cost-Effectiveness Analysis of Sacubitril/Valsartan for the Treatment of Heart Failure with Reduced Ejection Fraction in the United States. Pharmacother-apy 2018;38:520-530.
18. Gandjour A, Ostwald DA. Sacubitril/Valsartan (LCZ696): A Novel Treatment for Heart Failure and its Estimated Cost Effec-tiveness, Budget Impact, and Disease Burden Reduction in Germany. Pharmacoeconomics 2018;36:1285-1296.
19. van der Pol S, de Jong LA, Vemer P, Jansen DEMC, Postma MJ. Cost-Effectiveness of Sacubitril/Valsartan in Germany: An Application of the Efficiency Frontier. Value Health 2019;22:1119-1127.
20. van der Pol S, Degener F, Postma MJ, Vemer P. An Economic Evaluation of Sacubitril/Valsartan for Heart Failure Patients in the Netherlands. Value Health 2017;20:388-396.
21. Ramos IC, Versteegh MM, de Boer RA, Koenders JMA, Linssen GCM, Meeder JG, Rutten-van Mölken MPMH. Cost Effec-tiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch Phar-macoeconomic Guidelines. Value Health 2017;20:1260-1269.
22. Chin KL, Zomer E, Wang BH, Liew D. Cost-Effectiveness of Switching Patients With Heart Failure and Reduced Ejection Fraction to Sacubitril/Valsartan: The Australian Perspective. Heart Lung Circ 2020;29:1310-1317.
23. Perera K, Ademi Z, Liew D, Zomer E. Sacubitril-valsartan versus enalapril for acute decompensated heart failure: a cost-effectiveness analysis. Eur J Prev Cardiol 2021;28:966-972.
24. Liang L, Bin-Chia Wu D, Aziz MIA, Wong R, Sim D, Leong KTG, Wei YQ, Tan D, Ng K. Cost-effectiveness of sacubi-tril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction. J Med Econ 2018;21:174-181.
25. McMurray JJV, Trueman D, Hancock E, Cowie MR, Briggs A, Taylor M, Mumby-Croft J, Woodcock F, Lacey M, Haroun R, Deschaseaux C. Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction. Heart 2018;104:1006-1013.
26. Ademi Z, Pfeil AM, Hancock E, Trueman D, Haroun RH, Deschaseaux C, Schwenkglenks M. Cost-effectiveness of sacubi-tril/valsartan in chronic heart-failure patients with reduced ejection fraction. Swiss Med Wkly 2017;147:w14533.
27. Krittayaphong R, Permsuwan U. Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand. Am J Cardiovasc Drugs 2018;18:405-413.
28. Borges M, Afonso-Silva M, Laires PA, Gouveia M, Alarcão J, Ascenção R, Costa J. Cost-effectiveness of sacubitril/valsartan for the treatment of patients with heart failure with reduced ejection fraction in Portugal. Expert Rev Pharmacoecon Out-comes Res 2020;20:199-205.
29. Park SK, Hong SH, Kim H, Kim S, Lee EK. Cost-Utility Analysis of Sacubitril/Valsartan Use Compared With Standard Care in Chronic Heart Failure Patients With Reduced Ejection Fraction in South Korea. Clin Ther 2019;41:1066-1079.
30. Perera K, Ademi Z, Liew D, Zomer E. Sacubitril-valsartan versus enalapril for acute decompensated heart failure: a cost-effectiveness analysis. European journal of preventive cardiology. 2019:2047487319878953.
31. Consortium YHE. Incremental Cost-Effectiveness Ratio (ICER) UK2016. https://yhec.co.uk/glossary/incremental-cost-effectiveness-ratio-icer/(01 October 2022).
32. Consortium YHE. Cost-Effectiveness Threshold: York Health Economics Consortium; 2016 [Available from: https://yhec.co.uk/glossary/cost-effectiveness-threshold/. (01 October 2022).
33. Krittayaphong R, Permsuwan U. Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand. Am J Cardiovasc Drugs 2018;18:405-413.
34. Liu XQ, He LS, Huang JQ, Xiong LJ, Xia C, Lao HY. Cost-effectiveness analyses of sacubitril-valsartan for heart failure. Heart Fail Rev 2021;26:1119-1130.
| Files | ||
| Issue | Vol 17 No 4 (2022): J Teh Univ Heart Ctr | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i4.11603 | |
| Keywords | ||
| Cost-effectiveness analysis Sacubitril-valsartan Heart Failure; epidemiology Heart Failure; therapy Systematic review | ||
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How to Cite
1.
Rezapour A, Azari S, Arabloo J, Kolivand P, Behzadifar M, Omidi N, Sarabi Asiabar A, Saberian P, Pourasghari H, Bragazzi N, Mehrani M, Shahi S, Tajdini M. Cost-Effectiveness of Sacubitril/Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review. J Tehran Heart Cent. 2022;17(4):168-179.
