OBJECTIVES: A previously published study demonstrated that sacubitril/valsartan is considered cost-effective for patients with HFrEF compared with enalapril in Thai setting. In addition to the economic value, this study aimed to estimate the budget impact of adding sacubitril/valsartan to the national reimbursement from the payer’s perspective.

METHODS: A budget impact model was developed to project the 5-year budget impact of including sacubitril/valsartan in the national drug list for subpopulations of patients with HFrEF, including 1.) patients who remain symptomatic despite treatment with ACE inhibitor or angiotensin receptor blocker (ARB); and 2.) patients with rehospitalization. Clinical benefits were derived from the PARADIGM-HF study. Epidemiology data, hospitalization and mortality costs were obtained from published literature. Sacubitril/valsartan price expected for national formulary listing was used, and other drug prices were those published by Ministry of Public Health, Thailand. Sensitivity analysis was performed to assess the effect of data uncertainty.

RESULTS: Comparing with ACE inhibitor/ARB, sacubitril/valsartan yielded 4.9% and 1.4% reductions in the annual probabilities of hospitalization and mortality, respectively, which translated into 1,709 hospitalizations avoided and 488 deaths avoided in patients with symptomatic HFrEF, and 843 hospitalizations avoided and 241 deaths avoided in patients with rehospitalization over 5 years. The inclusion of sacubitril/valsartan in the national drug list resulted in 5-year cumulative cost savings of USD 2.96M and 1.46M in patients with symptomatic HFrEF and patients with rehospitalization, respectively. The annual net budget impact from the first to the fifth years ranged from USD 2.63M to 7.71M and USD 1.30M to 3.80M for such patient subpopulations.

CONCLUSIONS: The inclusion of sacubitril/valsartan in the national drug list has the potential to reduce hospitalization, increase lives saved, and save costs associated with hospitalization and mortality. The results can be used to support decision-making process to add sacubitril/valsartan to the national reimbursement in Thailand.