Publication: Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand
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Issued Date
2018-10-01
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ISSN
1179187X
11753277
11753277
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2-s2.0-85048809411
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Cardiovascular Drugs. Vol.18, No.5 (2018), 405-413
Suggested Citation
Rungroj Krittayaphong, Unchalee Permsuwan Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand. American Journal of Cardiovascular Drugs. Vol.18, No.5 (2018), 405-413. doi:10.1007/s40256-018-0288-x Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/46290
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Title
Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in Thailand
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Abstract
© 2018, Springer International Publishing AG, part of Springer Nature. Background: Sacubitril-valsartan is a new medication that has recently been recommended as a replacement for enalapril in the treatment of patients with heart failure with reduced ejection fraction (HFrEF). Objective: This study aimed to determine the cost effectiveness of sacubitril-valsartan compared with enalapril. Methods: An analytical decision model was developed to estimate the long-term costs and outcomes from a healthcare perspective. Clinical inputs were mostly derived from the PARADIGM-HF study. Enalapril-related costs, risk of non-cardiovascular death, and all-cause readmission rate were based on data from Thailand. The costs and outcomes were discounted at 3% annually. The incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2017. A series of sensitivity analyses were also performed. Results: For the base-case, the increased cost (144,146 vs. 16,048 Thai baht [THB]) of sacubitril-valsartan was associated with gains in both life-years (9.214 vs. 8.367 years) and quality-adjusted life-years (QALYs) (7.698 vs. 6.909) compared with enalapril, yielding an ICER of 162,276 THB/QALY ($US4857.11/QALY). This ICER is not considered to be cost effective at the willingness-to-pay (WTP) level of 160,000 THB/QALY. The risk of cardiovascular death and costs of both sacubitril-valsartan and hospitalization influenced the ICER. At a WTP of 160,000 THB/QALY, sacubitril-valsartan had a 48% probability of being a cost-effective treatment. Conclusions: At its current price in Thailand, sacubitril-valsartan may not represent good value for the nations’s limited healthcare resources. The cost of sacubitril-valsartan needs to reduce by approximately 2% to yield an ICER below the threshold.