22 Jun Entresto (valsartan/sacubitril) Extends Life and Reduces Hospitalizations and Costs in Heart Failure Patients
MedicalResearch.com Interview with:
Thomas Andrew Gaziano, MD, MSc
Department of Cardiology
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Heart failure (HF) is the leading cause of admissions to hospitals in the United States and the associated costs run between $24-47 billion annually. Targeting neurohormonal pathways that aggravate the disease has the potential to reduce admissions. Enalapril, an angiotensin converting enzyme-inhibitor (ACEI), is more commonly prescribed to treat HF than Sacubitril/Valsartan, an angiotensin-receptor/neprilysin inhibitor (ARNI). The latter was shown to reduce cardiovascular death and hospitalizations due to heart failure in a multi-country, randomized clinical (PARADIGM-HF), compared to Enalapril. In order to assess the cost-effectiveness of Sacubitril/Valsartan, compared to Enalapril, in the United States, we created a model population with population characteristics equivalent to the population in the PARADIGM-HF trial. Using a 2-state Markov model we simulated HF death and hospitalizations for patients with a left ventricular ejection fraction (LVEF) of 40% or less.
MedicalResearch.com: What are the main findings?
Response: Our study estimated the cost-effectiveness of sacubitril/valsartan. For US patients with heart failure and a reduced ejection fraction of less than 40%, sacubitril/valsartan is a cost-effective intervention which could prevent additional hospitalizations and premature death. When compared with enalapril, sacubitril/valsartan extends life, reduces hospitalizations, and has an incremental cost-effectiveness ratio of US $45 017 per quality-adjusted life-year gained in the United States, which is comparable to many other commonly used medical interventions such as statins, percutaneous coronary interventions, and implantable cardiac defibrillators. This is significant because cost has been suggested as a factor that will influence patient use of sacubitril/valsartan while its use could lead to the prevention of thousands of premature deaths and hospitalizations for patients with heart failure.
Because of the additional life expectancy with 5.7 million individuals in the United States with HF, the benefits of expanded use of sacubitril/valsartan could be large. Over a lifetime of use it could lead to an increase in life expectancy of over 1 year. For every 100,000 people receiving sacubitril/valsartan, hospitalizations could be reduced by 3,000 and reduce deaths by nearly the same number over a two-year period. Medical savings from reduced HF admissions would be more than $27 million per year in the same number of treated patients.
MedicalResearch.com: What should readers take away from your report?
Response: Clinicians should consider sacubitril/valsartan as a cost-effective addition or alternative to current high-value interventions for patients with heart failure and reduced ejection fraction
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Other countries should consider similar evaluations of this effective medication in their setting where costs, hospitalization rates, and willingness to pay thresholds may differ.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Thomas A. Gaziano, MD, MSc; Gregg C. Fonarow, MD; Brian Claggett, PhD; Wing W. Chan, MS; Celine Deschaseaux-Voinet, MPH; Stuart J. Turner, MPH; Jean L. Rouleau, MD; Michael R. Zile, MD; John J. V. McMurray, MD; Scott D. Solomon, MD. Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction. JAMA Cardiology, June 2016 DOI: 10.1001/jamacardio.2016.1747
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Last Updated on June 22, 2016 by Marie Benz MD FAAD