OBJECTIVES: Assess the budget impact of sacubitril/valsartan (Sac/Val) an Angiotensin Receptor Neprilysin Inhibitor (ARNI) versus enalapril, an Angiotensin Converting Enzyme inhibitor (ACEi), for the treatment of heart failure with reduced ejection fraction (HFrEF) from an Algerian hospital perspective.

The PARADIGM-HF study demonstrated a significant risk reduction of cardiovascular deaths by 20% and hospitalizations for heart failure (HF) by 21% with Sac/Val versus enalapril.

METHODS: A budget impact model was developed to estimate the impact of Sac/Val introduction in HF treatment strategy on hospitalization and mortality costs. A cohort of patients with HFrEF was modeled by using the epidemiological data (HF prevalence, rates of patients with HFrEF in NYHA class II to IV and treated with ACEi/ARBs). Hospitalizations and mortality results were derived from PARADIGM-HF study.

The analysis was performed from the perspective of Algerian hospital assuming cost for hospitalization. Drug costs were not included. Annual and cumulative costs were estimated in Algerian Dinar (1US$= 131.87 DZD) considering a time horizon of five years.

RESULTS: At year 5, the treatment with Sac/Val, saves 323 deaths and 1131 all-cause hospitalizations. Over 5 years, 962 deaths are avoided, and 3368 hospitalizations are avoided. From a budget impact perspective, the formulary listing of Sac/Val into public hospitals in Algeria will translate into cumulative cost savings of about 5.77M DZD (43750 USD) for deaths avoided and 166M DZD (1.26 MUSD) for hospitalizations avoided. Total savings at Year 5 are 57M DZD (432000 USD) and cumulative total cost savings exceed 172M DZD (1.3M USD).

CONCLUSIONS: From the Algerian hospital perspective, Sac/Val introduction into HF treatment strategy has the potential to generate substantial savings over 5 years of more than 172M DZD (1.3M USD). An analysis from a broader perspective (including drug costs) should be conducted.