OBJECTIVES : To analyze the cost-effectiveness of sacubitril/valsartan versus usual care in heart failure patients with reduced ejection fraction (HFrEF) New York Heart Association (NYHA) Class II-IV, in Costa Rica.

METHODS : Previously developed UK cost-effectiveness model based on PARADIGM-HF (McMurray, 2014) trial was adapted to Costa Rica using Latin-American trial subgroup (N=1,433) and Costa Rica-specific epidemiologic and economic data to assess the impact of sacubitril/valsartan versus usual care (ACEi). 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, hospitalization, and adverse events. Quality-adjusted-life years (QALY) were derived from PARADIGM-HF. Costs (2017- colones - ₡) include drug, hospitalization and resources. Primary outcome was cost-utility (cost/QALY gained) over a 30-year time horizon. Sensitivity analyses were performed.

RESULTS : Base-case results suggest that compared to ACEi, sacubitril/valsartan is associated with incremental costs of ₡3,385,614 and 0.53 QALYs gained, with an incremental cost-effectiveness ratio of ₡6,400,593 per QALY gained. Increased costs of pharmacological therapy were offset by reductions in hospitalization costs. All-cause– and CV-related mortality estimates were reduced at all time points. Expected survival estimates increased from 5.84 years for those receiving an ACEi to 6.45 years for those receiving sacubitril/valsartan. Overall, results were not sensitive to changes in model parameters; results were most sensitive to CV mortality estimates and treatment-effect duration.

CONCLUSIONS : The Costa Rica-adapted model estimates suggest that sacubitril/valsartan represents a cost-effective intervention in the treatment of HFrEF (NYHA Class II-IV) versus ACEi, assuming a willingness-to-pay threshold of 3 times per capita GDP in Costa Rica (₡25,807,290). Consequently, sacubitril/valsartan represents reasonable value compared with other commonly accepted health care interventions.