OBJECTIVES: Sacubitril/valsartan (sac/val) showed a significant benefit in patients with heart failure, either hospitalized or ambulatory in clinical trials, but as earlier it started greater the benefit was. Despite the fact that sac/val has more benefits starting just from hospitalization, it is not always implemented. This study aims to evaluate the cost-effectiveness of the treatment with sac/val either in an inpatient or outpatient setting 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 hospital-initiated versus discharge-initiated. 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 hospital-initiated was associated with an increment of 0.08 quality-adjusted life years (QALY) and an additional cost of €585 €. The incremental cost-effectiveness ratio (ICER) was 7,372 €/QALY. The results of the probabilistic sensitivity analysis were similar (average ICER 7,313 €/QALY) and show that considering a €30,000 threshold, sac/val was cost-effective in 100% of cases. (This proportion remains 100% considering a €25,000 €/QALY).

CONCLUSIONS: Apart from the clinical benefit, starting with sac/val in hospitalized patients versus outpatients seems to be cost-effective. Sac/val should be started at the moment of hospitalization in terms of efficiency.