Arrhythmology Unit, Cardiovascular and Thoracic Department, AOU Senese, Siena, Italy.
Department of Health Policy, London School of Economics and Political Science, London, UK.
J Cardiovasc Med (Hagerstown). 2018 Oct;19(10):597-605. doi: 10.2459/JCM.0000000000000708.
The availability of novel drugs might affect the modern interplay between pharmacological and device therapy of heart failure with reduced ejection fraction (HFrEF). The aim of this study was to assess the cost-effectiveness of sacubitril/valsartan as compared with an implantable cardioverter-defibrillator (ICD) on top of optimal medical therapy in patients with HFrEF.
Data from 2000 adults with demographic and clinical characteristics similar to those in the PARADIGM-HF were derived as inputs for a four-state Markov model simulated HFrEF. Probabilities of all-cause mortality, heart failure hospitalization and ICD-related complications along with quality of life data and costs, discounted at 3%, from an Italian healthcare payer perspective were projected over a 10-year time horizon. Sensitivity analyses on key inputs were performed.
According to the model, sacubitril/valsartan would lead to 5.85 life years saved, whilst reducing by more than 20% the risk of heart failure hospitalizations for 1000 patients with HFrEF over 10 years. Estimated incremental costs with sacubitril/valsartan were -&OV0556;13 302 associated with incremental 0.14 quality-adjusted life years gained, yielding an incremental cost-effectiveness ratio of -&OV0556;98 500 per quality-adjusted life year gained for the base-case consistent with a dominant, cost-saving and clinically superior treatment strategy. Sacubitril/valsartan was dominant in more than 80% of the scenarios explored with sensitivity analyses.
The findings of this model suggest that in patients with HFrEF sacubitril/valsartan would be cost-effective by increasing survival at lower costs compared with an ICD. Sensitivity analyses confirmed the cost-effectiveness of sacubitril/valsartan that remained dominant across most of the ranges of the variables tested.
新型药物的出现可能会影响心力衰竭伴射血分数降低（HFrEF）的药理学和器械治疗的现代相互作用。本研究旨在评估与最佳药物治疗相比，沙库巴曲缬沙坦在 HFrEF 患者中与植入式心脏复律除颤器（ICD）联合应用的成本效益。
从与 PARADIGM-HF 相似的人口统计学和临床特征的 2000 名成年人中提取数据，作为模拟 HFrEF 的四状态马尔可夫模型的输入。从意大利医疗保健支付者的角度预测所有原因死亡率、心力衰竭住院和 ICD 相关并发症的概率，以及 10 年时间内的生活质量数据和成本，贴现率为 3%。对关键输入进行了敏感性分析。
根据模型，沙库巴曲缬沙坦可使 5.85 个生命年得到挽救，同时可降低 1000 例 HFrEF 患者 10 年内心力衰竭住院的风险超过 20%。与沙库巴曲缬沙坦相关的增量成本为 -&OV0556;13302 欧元，增量质量调整生命年增加 0.14 个，增量成本效益比为 -&OV0556;98500 欧元/质量调整生命年，与主要、节省成本和临床更优的治疗策略一致。在敏感性分析中，沙库巴曲缬沙坦在超过 80%的方案中均占主导地位。
该模型的研究结果表明，与 ICD 相比，沙库巴曲缬沙坦可通过提高生存率和降低成本使 HFrEF 患者的治疗具有成本效益。敏感性分析证实了沙库巴曲缬沙坦的成本效益，在大多数测试变量范围内仍然占主导地位。
