OBJECTIVES: Heart failure is a highly prevalent pathology that greatly affects the survival and quality of life of patients. Despite sacubitril/valsartan (sac/val) has demonstrated its effectiveness versus enalapril among patients with heart failure with reduced ejection fraction (HFrEF) in the clinical trials, its prescription remains restricted due to being more expensive than other treatment alternatives like the ACE inhibitors. The aim of this study is to evaluate the cost-effectiveness in outpatient settings of sac/val 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 versus enalapril. 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 was associated with an increment of 0.95 quality-adjusted life years (QALY) and an additional cost of €17,383 €. The incremental cost-effectiveness ratio (ICER) was 18,352 €/QALY. The results of the probabilistic sensitivity analysis were similar (average ICER 20,046 €/QALY) and show that considering a €30,000 threshold, sac/val was cost-effective in 95.8% of cases. (This proportion was 86.4% considering a €25,000 €/QALY).

CONCLUSIONS: With the premises considered in this study, sac/val in HFrEF patients could be considered cost-effective from the Spanish Health System perspective.