OBJECTIVES: Sacubitril/valsartan (SAC/VAL) and angiotensin receptor blockers (ARB) are recommended therapy for heart failure with preserved ejection fraction (HFpEF), but little is known about their real-world comparative effectiveness and costs. We aimed to assess comparative effectiveness of SAC/VAL vs. ARB for preventing HF-related and all-cause hospitalizations in patients with HFpEF and their related medical costs.

METHODS: We conducted a cohort study of patients with diagnosed HFpEF aged > 18 years who initiated SAC/VAL (2015-2020) or ARB (2009-2014) using MarketScan^® Commercial and Medicare Supplemental databases. Patients were required to have continuous enrolment in any commercial health benefit plan 6 months prior to the prescription fill date (index date) for inclusion in clinical outcome models. For economic outcomes, pre-index continuous enrolment was also required; however, we excluded patients if they had capitated health benefit plans. After 1 up to 3 propensity score matching, Cox proportional hazards regression models were used with robust variance estimators to compare HF-related and all-cause hospitalizations between the SAC/VAL and ARB users. We compared the post- treatment medical costs (HF-related and all-cause costs) per patient per month considering HF-related or any-cause services using a two-part model.

RESULTS: After propensity score matching, 2,520 patients (846 SAC/VAL users and 1,674 ARB users) were included in the clinical outcomes cohort and 1,705 (553 SAC/VAL users and 1,152 ARB users) in economic outcomes cohort. There was no significant differences in risk of HF-related hospitalization (adjusted hazard ratio [aHR], 0.95; 95% confidence interval [CI], 0.76-1.18; p=0.63) and all-cause hospitalization (aHR, 0.92; 95% CI, 0.80-1.04; p=0.18) between SAC/VAL and ARB groups. There was no significant differences in HF-related ($4,303 vs. $1,952, p=0.07) and all-cause ($7,877 vs. $6,432, p=0.32) medical costs between SAC/VAL and ARB users.

CONCLUSIONS: SAC/VAL and ARB users did not differ significantly in the risk of HF-related and all-cause hospitalizations and related medical costs.