Abstract

Objectives

Heart failure (HF) imposes a significant economic burden on the health system. This study evaluated the cost-effectiveness of adding ivabradine to standard pharmacotherapy compared with standard pharmacotherapy alone for treating eligible Vietnamese patients with HF.

Methods

A monthly cycle Markov model was developed, consisting of 5 health states (NYHA class I-IV and mortality) to simulate a cohort of patients with HF with sinus rhythm, left ventricular ejection fraction below 35%, and a baseline heart rate of ≥70 beats per minute over a lifetime horizon. Treatment effectiveness, transition probabilities, and utility values were derived from the published literature and the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial. Direct medical costs were obtained from electronic medical records and national procurement data. An annual rate of 3% was applied for both costs and outcomes. One-way and probabilistic sensitivity analyses were performed.

Results

Ivabradine plus standard pharmacotherapy was associated with an incremental cost of VND 74 115 747 (USD 3035.04) and an incremental gain of 0.28 quality-adjusted life-years (QALYs), leading to an incremental cost-effectiveness ratio of VND 268 370 919 per QALY (USD 10 989.80 per QALY). The monthly cost of ivabradine was the most influential parameter affecting the incremental cost-effectiveness ratio. There is a 71.4% probability of ivabradine plus standard pharmacotherapy being cost-effective at a willingness-to-pay threshold of VND 305 700 000 per QALY (USD 12 518.43 per QALY).

Conclusion

From a Vietnamese health system perspective, adding ivabradine to standard pharmacotherapy is likely to be a cost-effective strategy for treating eligible patients with HF. This evidence supports value-based pricing in price negotiations and efficient resource use.