Sacubitril/Valsartan Vs Enalapril Use in Hospitalized Patients with Heart Failure in Spain

OBJECTIVES: Heart failure is the most common reason for admission in almost all hospitals in Spain. Heart failure admissions are related to poor outcomes. The use of sacubitril/valsartan (sac/val) in hospitalized patients showed a greater benefit in the PIONEER-HF trial. Even though sac/val has demonstrated its effectiveness among patients hospitalized for HFrEF, its prescription remains restricted during hospital admissions. The aim of this study is to evaluate the cost-effectiveness in the inpatient settings of Sac/val in patients with HFrEF from the perspective of the Spanish Health System.

METHODS: A 5-state Markov model was used to compare the cost-effectiveness of sac/val versus enalapril. A time horizon of 30 years and the perspective of the NHS was used. Future costs and effects were discounted at a 3% rate. Transition probabilities for each 1-month cycle were obtained from PARADIGM-HF and PIONEER-HF studies, direct health-care costs (€2022) from national databases, and time-dependent utilities from a mixed model analysis of PARADIGM-HF from literature.

RESULTS: Sac/val was associated with an increment of 1.03 quality-adjusted life years (QALY) and an additional cost of €17,948 €. The incremental cost-effectiveness ratio (ICER) was 17,502 €/QALY. The results of the probabilistic sensitivity analysis were similar (average ICER 18,826 €/QALY) and show that considering a €30,000 threshold, sac/val was cost-effective in 99.5% of cases. (This proportion was 97.4% considering a €25,000 €/QALY).

CONCLUSIONS: The results of this study show that the early use of sac/val during the admission of HFrEF patients could be considered cost-effective, from the Spanish Health System perspective.