Cost-Effectiveness Model of Ranolazine for Treating Chronic Stable Angina Patients From Kingdom of Saudi Arabia Perspective
Author(s)
Rashmika Sharma, MA1, Minal Jain, MD, MPH1, Elisabetta Fenu, MPharm, MIHMEP2, Rima Jamal El khatib, BS2, Santiago Moreno, PhD2, Fakhr Alayoubi, MSC, RPHARM, MBA3.
1RxPremise Solutions Pvt. Ltd., Noida, India, 2Menarini Group, Florence, Italy, 3King Saud University Medical City, Riyadh, Saudi Arabia.
1RxPremise Solutions Pvt. Ltd., Noida, India, 2Menarini Group, Florence, Italy, 3King Saud University Medical City, Riyadh, Saudi Arabia.
OBJECTIVES: To develop a cost-effectiveness model for ranolazine among chronic stable angina (CSA) patients who remain symptomatic despite anti-anginal treatment, from the Kingdom of Saudi Arabia (KSA) payer perspective. This development was informed by a comprehensive targeted literature review of existing global economic models for ranolazine.
METHODS: The review of existing models demonstrated ranolazine's consistent cost-effectiveness, largely due to reduced angina severity and subsequent lower resource utilization. This insight, along with the importance of stratifying outcomes by angina severity and including revascularization impacts, guided the development of a 1-year decision tree model which compared ranolazine+sublingual nitro-glycerine (SNG) against placebo+SNG and trimetazidine+SNG. Trimetazidine was selected as the comparator due to its lower cost, high prevalence (approximately 95%) in Saudi Arabian second-line treatments, and superior safety profile compared to Ivabradine. The model tracked angina frequency, hospitalization, and revascularization, with all-cause mortality considered in a scenario analysis. Clinical inputs and utility values were derived from published literature (specific for ranolazine and each comparator), and direct healthcare costs, including drug acquisition, diagnostic tests, outpatient visits, hospitalizations, and revascularization procedures, were incorporated. The analysis determined the Incremental Cost-Effectiveness Ratio (ICER), and one-way sensitivity analysis (OWSA) was conducted to ensure the robustness of the findings.
RESULTS: Ranolazine incurred higher one-year total costs (SAR 7,127 vs. SAR 6,481 for placebo; SAR 6,494 vs. SAR 6,109 for trimetazidine) but delivered significantly more QALYs (0.6623 vs. 0.5525 with placebo; 0.7579 vs. 0.7441 with trimetazidine). This resulted in favourable ICERs of SAR 5,883/QALY vs. placebo and SAR 28,017/QALY vs. trimetazidine, both well below the Saudi Arabia’s SAR 50,000/QALY willingness-to-pay threshold. OWSA identified utility and hospitalization as key drivers for ICER.
CONCLUSIONS: Ranolazine is a cost-effective treatment compared to placebo and trimetazidine from KSA payor perspective. These findings are vital for optimizing healthcare resource allocation and ensuring patient access amidst rising costs.
METHODS: The review of existing models demonstrated ranolazine's consistent cost-effectiveness, largely due to reduced angina severity and subsequent lower resource utilization. This insight, along with the importance of stratifying outcomes by angina severity and including revascularization impacts, guided the development of a 1-year decision tree model which compared ranolazine+sublingual nitro-glycerine (SNG) against placebo+SNG and trimetazidine+SNG. Trimetazidine was selected as the comparator due to its lower cost, high prevalence (approximately 95%) in Saudi Arabian second-line treatments, and superior safety profile compared to Ivabradine. The model tracked angina frequency, hospitalization, and revascularization, with all-cause mortality considered in a scenario analysis. Clinical inputs and utility values were derived from published literature (specific for ranolazine and each comparator), and direct healthcare costs, including drug acquisition, diagnostic tests, outpatient visits, hospitalizations, and revascularization procedures, were incorporated. The analysis determined the Incremental Cost-Effectiveness Ratio (ICER), and one-way sensitivity analysis (OWSA) was conducted to ensure the robustness of the findings.
RESULTS: Ranolazine incurred higher one-year total costs (SAR 7,127 vs. SAR 6,481 for placebo; SAR 6,494 vs. SAR 6,109 for trimetazidine) but delivered significantly more QALYs (0.6623 vs. 0.5525 with placebo; 0.7579 vs. 0.7441 with trimetazidine). This resulted in favourable ICERs of SAR 5,883/QALY vs. placebo and SAR 28,017/QALY vs. trimetazidine, both well below the Saudi Arabia’s SAR 50,000/QALY willingness-to-pay threshold. OWSA identified utility and hospitalization as key drivers for ICER.
CONCLUSIONS: Ranolazine is a cost-effective treatment compared to placebo and trimetazidine from KSA payor perspective. These findings are vital for optimizing healthcare resource allocation and ensuring patient access amidst rising costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE231
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas