OBJECTIVES: To estimate the cost-effectiveness of sacubitril/valsartan versus enalapril in the treatment of heart failure patients with reduced ejection fraction (HFrEF) New York Heart Association (NYHA) Class II-IV, under the Brazilian Unified Health System (SUS) perspective.

METHODS: Previously developed cost-effectiveness model based on PARADIGM-HF trial was adapted to Brazil using Latin-American trial subgroup (N=1,433) and Brazil-specific epidemiologic and economic data. A regression-based (Markov) cost-utility model with one month cycling was utilized to examine a hypothetical cohort of HFrEF patients. Clinical outcomes included mortality, all-cause hospitalization and adverse events. Quality-adjusted-life years (QALY) were derived from PARADIGM-HF. Costs (BRL) include drug, hospitalization and medical resources estimated from 2017. Primary outcome was cost-utility (cost/QALY gained) over a 30-year time horizon. Univariate and probabilistic sensitivity analyses were performed.

RESULTS: Base-case results suggest that compared to enalapril, sacubitril/valsartan is associated with incremental costs of BRL14,043 and 0.50 QALYs gained, with an incremental cost-effectiveness ratio of BRL28,154 per QALY gained. Increased costs of pharmacological therapy were offset by reductions in hospitalization costs. All-cause– and cardiovascular-related mortality estimates were reduced at all time points. Expected survival estimates increased from 5.67 years for those receiving enalapril to 6.24 years for those receiving sacubitril/valsartan. Overall, results were not sensitive to changes in model parameters; results were most sensitive to cardiovascular mortality estimates and treatment-effect duration.

CONCLUSIONS: The Brazil-adapted model estimates suggest that sacubitril/valsartan represents a cost-effective intervention in the treatment of HFrEF (NYHA Class II-IV) versus enalapril, assuming a willingness-to-pay threshold of 3 times per capita GDP in Brazil (BRL91,221). Consequently, sacubitril/valsartan represents a good value for money compared to enalapril under the Public Healthcare System in Brazil.