OBJECTIVES

: PARADIGM-HF, a phase III trial conducted in Heart Failure (HF) patients with reduced ejection fraction (HFrEF), showed that sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor for treatment of HFrEF, provided incremental cardiovascular and overall survival benefit compared with enalapril. This analysis aims to quantify the number of all-cause deaths and acute HF hospitalisations that could be avoided with optimal usage of sacubitril/valsartan in the treatment of HFrEF in Ireland.

METHODS

: Epidemiology data from the UK Clinical Practice Research Datalink was extrapolated to the Irish population by age and sex to estimate the national HF population. The target HF population, was then estimated based on a literature review of HFrEF and NYHA II-IV prevalence in Ireland. The number needed to treat (NNT) to avoid one death and one hospitalisation standardized to 12 months, was derived from the PARADIGM-HF trial. The potential number of deaths prevented or postponed and HF hospitalisations avoided with optimal sacubitril/valsartan treatment was estimated along with multi-way sensitivity analysis. The savings in acute hospital bed-days per annum were calculated based on the cost and Length of Stay (LoS) for HF patients.

RESULTS

: An estimated 92,000 people have HF in Ireland (1.9/100). Of those, approximately 50% are considered clinically diagnosed with NYHA class II –IV HF. Of these, 40.7% have HFrEF. Further adjustment for HFrEF ≤35% and contraindications (8.6%) yielded a target population of 14,985 patients. Based on a NNT of 80.3 (for both deaths and HF hospitalisations), optimal usage of sacubitril/valsartan was estimated to prevent 187 deaths and (187 x 11.44 LoS) acute hospital bed-days per annum. The cost savings from HF hospitalisations avoided is estimated at €1.22m.

CONCLUSIONS

: The findings from this analysis showed the cost savings, all-cause deaths and hospitalisations that could be prevented with optimal implementation of sacubitril/valsartan therapy for patients suitable for treatment.