OBJECTIVES: The rising prevalence of heart failure (HF) in midlife years in Indians is posing an economic challenge. Sacubitril/valsartan demonstrated a significant risk reduction of cardiovascular deaths by 20% and HF related hospitalizations by 21% versus enalapril but at a higher cost. We evaluated the cost-effectiveness of sacubitril/valsartan compared with enalapril for the treatment of patients with heart failure with reduced ejection fraction (HFrEF) from the Indian healthcare perspective.

METHODS: A previously published two-state Markov model with one-month cycle was adapted for Indian setting to estimate clinical and economic outcomes of sacubitril/valsartan vs. enalapril for HFrEF adult patients in India over a lifetime horizon. Costs as well as benefits were discounted at 3.5% annually and are presented in 2020 U.S. dollars (US$). Clinical and quality of life data were derived from PARADIGM-HF trial. Cost data was acquired from local published literature. When local data was not available, costs previously derived in United Kingdom were converted to Indian costs using healthcare-based PPP conversion factors from World Bank’s International Comparison Program. Primary outcomes were quality adjusted life years (QALY) and incremental cost-effectiveness ratio (ICER)s. A range of one to three times GDP per capita was used to determine if the generated ICERs were cost-effective for India.

RESULTS: Treatment with sacubitril/valsartan resulted in 5.71 QALYs at the cost of US$ 12,144, while enalapril yielded 5.13 QALYs at the cost of US$ 8,695. Compared with enalapril, sacubitril/valsartan was associated with an ICER of US$ 5,922 per QALY gained which was within the cost-effectiveness thresholds.

CONCLUSIONS: Our analysis suggest that, sacubitril/valsartan is likely to be cost-effective compared with enalapril in patients with HFrEF. Analysis results could support payers in selecting an appropriate treatment strategy for HFrEF patients.