Cost-Effectiveness Analysis of ARNI Compared to ACEI Among Heart Failure Patients With Reduced Ejection Fraction in Malaysia

Speaker(s)

Kuan WC1, Ademi Z2, Lee SW3, Ong SC4, Chee KH5, Kasim S6, Raja Shariff RE6, Mohd Ghazi A7, SK Abdul Kader MA8, Lim KK9, Shetty S10, Fox-Rushby J10, Dujaili J11, Lee KKC12, Teoh SL12
1Monash University, Bandar Sunway, 10, Malaysia, 2Monash University, Melbourne, VIC, Australia, 3Malaysia Health Technology Assessment Section (MaHTAS), Precinct 1, Putrajaya, Malaysia, 4Universiti Sains Malaysia, Penang, Penang, Malaysia, 5University of Malaya, Kuala Lumpur, Kuala Lumpur, Malaysia, 6Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia, 7National Heart Institute, Kuala Lumpur, Kuala Lumpur, Malaysia, 8Hospital Serdang, Ministry of Health Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia, 9King's College London, London , LON, UK, 10King's College London, London, London, UK, 11Swansea University, Swansea, Wales, UK, 12Monash University, Subang Jaya, Selangor, Malaysia

Presentation Documents

OBJECTIVES: This study aimed to compare the costs and effectiveness of angiotensin receptor neprilysin inhibitor (ARNI) with angiotensin-converting enzyme inhibitors (ACEI) for heart failure with reduced ejection fraction (HFrEF) population from the Malaysian Ministry of Health (MoH)’s perspective.

METHODS: A 3-state Markov model, with a monthly cycle, was constructed to estimate the lifetime healthcare costs, quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER). Kaplan-Meier curves from the PARADIGM-HF trial were reconstructed to estimate the monthly baseline risks for all-cause mortality and HF hospitalisation, which were age-adjusted to the Malaysian population. The relative treatment effects were obtained from the PARADIGM-HF trial. Time-dependent risks for all-cause mortality from hospitalisation, and utility values were derived from local observational studies. The cost of medicines, disease management and HF hospitalisation were derived from MoH hospitals. The cost of cardiovascular death was estimated from the ADVANCE trial (Malaysia datasets). All costs were adjusted to 2023 Malaysian Ringgit. The ICER was compared to RM55,426 per QALY (one-time Gross Domestic Product per capita).

RESULTS: Despite ARNI being more expensive than ACEI, it gained more QALYs, resulting in an ICER of RM46,498 per QALY. One-way sensitivity analysis found that the ICER was sensitive to the relative treatment effects on CV mortality, duration of treatment effects, and time horizon. At cost-effectiveness threshold of RM55,462 per QALY, probabilistic analysis estimated that the ARNI was cost-effective in 66% simulations. Scenario analysis demonstrated that initiation of SGLT-2i alongside ARNI was more cost-effective than ARNI alone.

CONCLUSIONS: At cost-effectiveness threshold of RM55,426 per QALY, replacing ACEI with ARNI for HFrEF patients in Malaysia is likely a cost-effective use of resources. Addition of SGLT-2i in the backbone therapies with ARNI should be considered to maximise the value of ARNI.

Code

EE673

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory)