OBJECTIVES: To simulate the long-term clinical performance and cost-effectiveness of Sacubitril/Valsartan for the treatment of essential hypertension from a Chinese healthcare system perspective.

METHODS: A Markov model with five health states was constructed including hypertension without history of cardiovascular disease, post-coronary heart disease (CHD), post-stroke, post both CHD and stroke, and death. The cost per quality-adjusted life-year (QALY) gained with Sacubitril/Valsartan compared to Allisartan Isoproxil and Valsartan were estimated over a lifetime horizon with an annual cycle. Multivariate risk functions and hazard ratios were used to transform the dual mechanism of Sacubitril/Valsartan to lower blood pressure and left ventricular mass index (LVMI) to fatal and non-fatal cardiovascular disease risks. Efficacy data were calculated from a network meta-analysis based on published clinical trials and observational studies. Healthcare costs, reported in 2020 Chinese Yuan, were determined from literature, supplemented by expert consultation. Utilities were derived from literature. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the model.

RESULTS: For simulated patients with hypertension (52.7% men, age 57.7 years, systolic blood pressure 157.9 mmHg, LVMI 98.0g/m²), Sacubitril/Valsartan reduced the rates of myocardial infarction by 6.67% and 6.39%, stroke by 9.38% and 8.98%, heart failure hospitalization by 9.92% and 9.62% relative to Allisartan Isoproxil and Valsartan. Lifetime costs per patient were CN¥59,110 for Sacubitril/Valsartan, CN¥54,602 for Allisartan Isoproxil, and CN¥55,488 for Valsartan; total QALYs were 11.38, 11.24 and 11.25 respectively. The cost-effectiveness ratio (ICER) was CN¥31,938/QALY compared with Allisartan Isoproxil, and CN¥27,252/QALY compared with Valsartan, all below the Chinese cost-effectiveness threshold of CN¥72,447/QALY (1 time per-capita GDP). Similar results were obtained in various sensitivity analysis scenarios.

CONCLUSIONS: Sacubitril/Valsartan compares favorably with Allisartan Isoproxil and Valsartan in Chinese setting, which is mainly resulted from its higher efficacy leading in the long run to fewer cardiovascular events, and ultimately its related mortalities.