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

METHODS: A 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 two-state regression-based (Markov) cost-utility model with one-month cycling was utilized to examine a hypothetical cohort of HFrEF patients, predicting events and outcomes (mortality, all-cause hospitalization, adverse events and health-related quality of life), adjusted according to baseline characteristics and time from randomization, for each treatment arm. Quality-adjusted-life years (QALY) were derived from PARADIGM-HF. Costs (BRL) include drug, hospitalization and medical resources estimated for private health sector 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 with enalapril, sacubitril/valsartan is associated with incremental costs of BRL17,352 and 0.50 QALYs gained, with an incremental cost-effectiveness ratio of BRL34,729 per QALY gained. Increased costs of pharmacological therapy were offset by reductions in hospitalization costs. All-cause– and cardiovascular mortality estimates were reduced at all time points. Expected survival estimates were greater among patients receiving sacubitril/valsartan versus those receiving enalapril (6.24 vs. 5.67 years). Overall, results were not sensitive to variation 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 the GDP per capita (1 x GDP 2017: BRL 31,587) per QALY gained. Consequently, sacubitril/valsartan represents a good value for money compared with enalapril under the Private Healthcare System in Brazil.