OBJECTIVES

: Assess the budget impact of sacubitril/valsartan (Sac/Val) an Angiotensin Receptors/Neprilysin Inhibitor (ARNI) versus enalapril, an Angiotensin Converting Enzyme inhibitor (ACEi), for the treatment of heart failure with reduced ejection fraction (HFrEF) from a Moroccan hospital perspective.

The PARADIGM-HF study demonstrated a significant risk reduction of cardiovascular deaths by 20% and hospitalizations for heart failure (HF) by 21% with Sac/Val versus enalapril.

METHODS

: A budget impact model was developed to estimate the impact of Sac/Val introduction in HF treatment strategy on hospitalization and mortality costs. A cohort of patients with HFrEF was modeled by using the epidemiological data (HF prevalence, rates of patients with HFrEF in NYHA class II to IV and treated with ACEi/ARBs). Hospitalizations and mortality results were derived from PARADIGM-HF study.

The analysis was performed from the perspective of Moroccan public health assuming DRG cost for hospitalization. Drug costs were not included. Annual and cumulative costs were estimated in Moroccan Dirhams (MAD; 1 EUR ≈ 10 MAD) considering a time horizon of five years.

RESULTS

: At year 5, the treatment with Sac/Val, saves 120 deaths and 420 all-cause hospitalizations. Over 5 years, 351 deaths are avoided, and 1228 hospitalizations are avoided. From a budget impact perspective, the introduction of Sac/Val into the national reimbursement list in Morocco will translate into cumulative cost savings of about 72 k MAD for deaths avoided and 8.1m MAD for hospitalizations avoided. Total savings at Year 5 are 2.85m MAD and cumulative total cost savings exceed 8.1m MAD.

CONCLUSIONS

: From the Moroccan hospital perspective, Sac/Val introduction into HF treatment strategy has the potential to generate substantial savings over 5 years of more than 8.1m MAD. An analysis from a broader perspective (including drug costs) should be conducted.