05 Apr New Combination Drug for Heart Failure Likely To Be Cost-Effective But Not Cost Saving

MedicalResearch.com Interview with:

Dr. Jordan B. King

Dr. Jordan B. King
Post Doctoral Fellow
Pharmacotherapy Outcome Resctr,
University of Utah

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The cornerstone of treatment in heart failure with reduced ejection fraction (HFrEF) revolves around low-cost generic medications such as angiotensin converting enzyme inhibitors (ACEIs) and beta-blockers (BBs). However, recently the dual-acting angiotensin receptor neprilysin inhibitor (ARNI) sacubitril-valsartan, demonstrated improved survival and reduction in heart failure hospitalizations relative to enalapril, an ACEI, and optimal background therapy. This creates a situation in which we have a new medication which improves outcomes, but carries a high price tag ($4,560 per year) compared with ACEIs, the standard of care over the last 20 years, and are available as generic medications for <$50 per year. We set out to determine the incremental cost-effectiveness ratio (ICER) per quality adjusted life year gained (QALY) from the perspective of a health care payer in the U.S. The ICER is a measure of how much we have to pay for sacubitril-valsartan to gain 1 unit of health relative to enalapril. In this case the unit of health is a year of life adjusted for quality.

We used a Markov model to estimate the costs and effectiveness of the two treatment options over a lifetime. In the base case, the ICER for sacubitril-valsartan was $50,959 per QALY gained. Health care interventions which cost <$50,000 per QALY are generally considered cost-effective, but some argue that <$100,000 per QALY is a more appropriate threshold in the U.S. In a probabilistic sensitivity analysis, 57% and 80% of all simulations fell below the $50,000 and $100,000 per QALY thresholds, respectively. Sacubitril-valsartan was the less costly treatment arm in 5% of simulations, and enalapril dominated (less costly and more effective) in 17% of simulations.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Sacubitril-valsartan is likely a cost-effective treatment option, but it is unlikely to be a cost-saving medication. The results of this study provide context around the price of sacubitril-valsartan that can be used to aid decision making. Ultimately, the decision to prescribe sacubitril-valsartan should include input from the patient. In most circumstances, patients will be required to pay more out of pocket costs for sacubitril-valsartan, limiting its use to patients who are willing to pay more.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: This effect of sacubitril-valsartan vs enalapril was based on a randomized controlled trial, and currently no real-world evidence is available. The topic of cost-effectiveness needs to be readdressed when real-world data is available. Also, we used a third party payer perspective in this analysis. Additional research is needed to assess cost-effectiveness from a health care system perspective and a patient perspective. 

MedicalResearch.com: Is there anything else you would like to add?

Response:

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

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More Medical Research Interviews on MedicalResearch.com

Dr. Jordan B. King (2016). New Combination Drug for Heart Failure Likely To Be Cost-Effective But Not Cost Saving MedicalResearch.com

Last Updated on April 5, 2016 by Marie Benz MD FAAD