van der Pol Simon, Degener Fabian, Postma Maarten J, Vemer Pepijn
Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Value Health. 2017 Mar;20(3):388-396. doi: 10.1016/j.jval.2016.10.015. Epub 2016 Dec 22.
In September 2014, the PARADIGM-HF trial showed the heart failure drug combination sacubitril/valsartan to be superior to enalapril for patients with a reduced ejection fraction.
To determine the incremental cost-effectiveness of sacubitril/valsartan compared with enalapril in the Netherlands using the clinical data from the PARADIGM-HF trial.
To compare sacubitril/valsartan and enalapril in a cost-effectiveness study, a Markov model was developed using the effectiveness data from the PARADIGM-HF trial. A health care payer's perspective was applied in the economic evaluation. The developed model was used to evaluate the cost-effectiveness for sacubitril/valsartan at different per diem prices.
The base-case analysis showed that sacubitril/valsartan can be cost-effective at maximum daily costs of €5.50 and €14.14 considering willingness-to-pay thresholds of €20,000 and €50,000 per quality-adjusted life-year (QALY), respectively. Sensitivity analysis demonstrated the robustness of the model, identifying only the price of sacubitril/valsartan and the mortality within the sacubitril/valsartan group as significant drivers of the cost-effectiveness ratio. Sacubitril/valsartan was cost-effective at a willingness-to-pay threshold of €20,000 per QALY (€50,000 per QALY) in more than 80% of the replications with certainty at the price point of €3 (€10).
Sacubitril/valsartan can be considered a cost-effective treatment at a daily price of €5.25. Unless priced lower than enalapril (<€0.045 per day), sacubitril/valsartan is very unlikely to be cost-saving/dominant.
2014年9月，PARADIGM-HF试验表明，对于射血分数降低的患者，心力衰竭药物组合沙库巴曲缬沙坦优于依那普利。
利用PARADIGM-HF试验的临床数据，确定在荷兰沙库巴曲缬沙坦与依那普利相比的增量成本效益。
为了在成本效益研究中比较沙库巴曲缬沙坦和依那普利，使用PARADIGM-HF试验的有效性数据建立了一个马尔可夫模型。在经济评估中采用了医疗保健支付者的视角。所建立的模型用于评估不同每日价格下沙库巴曲缬沙坦的成本效益。
基础病例分析表明，考虑到每质量调整生命年（QALY）的支付意愿阈值分别为20,000欧元和50,000欧元，沙库巴曲缬沙坦在每日最高成本为5.50欧元和14.14欧元时具有成本效益。敏感性分析证明了该模型的稳健性，仅将沙库巴曲缬沙坦的价格和沙库巴曲缬沙坦组内的死亡率确定为成本效益比的重要驱动因素。在超过80%的重复试验中，当支付意愿阈值为每QALY 20,000欧元（每QALY 50,000欧元）时，沙库巴曲缬沙坦在3欧元（10欧元）的价格点上具有成本效益。
沙库巴曲缬沙坦每日价格为5.25欧元时可被视为具有成本效益的治疗方法。除非价格低于依那普利（每天<0.045欧元），否则沙库巴曲缬沙坦极不可能节省成本/占主导地位。
