Chin Ken Lee, Zomer Ella, Wang Bing H, Liew Danny
CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Melbourne Medical School, The University of Melbourne, Melbourne, Vic, Australia.
CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Sep;29(9):1310-1317. doi: 10.1016/j.hlc.2019.03.007. Epub 2019 Apr 2.
The cost-effectiveness, from the Australian health care perspective, of switching patients with heart failure and reduced ejection fraction (HFREF) stable on angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) to the angiotensin receptor neprilysin inhibitor (ARNi) sacubitril/valsartan is unclear. We sought to assess the cost-effectiveness of sacubitril/valsartan versus enalapril in patients with HFREF in the contemporary Australian setting.
We developed a Markov model with two health states ('Alive' and 'Dead') to assess the cost-effectiveness of sacubitril/valsartan versus enalapril in patients with HFREF. Model subjects were 63 years of age at entry and had simulated follow-up over 20 years. Transition probabilities were derived from the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) study. Costs and utility data were derived from published sources. All costs and effects were discounted at an annual rate of 5% and are presented in Australian dollars. Sensitivity analyses were undertaken to test variability in key data inputs.
In the base-case analysis, sacubitril/valsartan was found to reduce non-fatal heart failure hospitalisations and cardiovascular deaths, with numbers-needed-to-treat over a 20-year period of 40 and 27, respectively. The use of sacubitril/valsartan led to an additional 6 months of life gained per patient, translating to A$27,954 per years of life saved (YoLS) and A$40,513 per quality-adjusted-life-years (QALY) gained. The results of the sensitivity analyses indicated that the results were robust.
Our analysis supports switching HFREF patients on ACE inhibitor or ARB to sacubitril/valsartan.
从澳大利亚医疗保健的角度来看，将射血分数降低的心力衰竭（HFREF）患者从稳定服用血管紧张素转换酶（ACE）抑制剂/血管紧张素II受体阻滞剂（ARB）转换为血管紧张素受体脑啡肽酶抑制剂（ARNi）沙库巴曲缬沙坦的成本效益尚不清楚。我们试图评估在当代澳大利亚环境下，沙库巴曲缬沙坦与依那普利相比在HFREF患者中的成本效益。
我们开发了一个具有两种健康状态（“存活”和“死亡”）的马尔可夫模型，以评估沙库巴曲缬沙坦与依那普利在HFREF患者中的成本效益。模型受试者入组时年龄为63岁，并模拟随访20年。转移概率来自于ARNI与ACEI对心力衰竭全球死亡率和发病率影响的前瞻性比较（PARADIGM-HF）研究。成本和效用数据来自已发表的资料。所有成本和效果均按每年5%的贴现率进行贴现，并以澳元表示。进行敏感性分析以测试关键数据输入的变异性。
在基础病例分析中，发现沙库巴曲缬沙坦可减少非致命性心力衰竭住院和心血管死亡，20年内的治疗人数分别为40人和27人。使用沙库巴曲缬沙坦使每位患者的生命延长了6个月，相当于每挽救一年生命（YoLS）花费27,954澳元，每获得一个质量调整生命年（QALY）花费40,513澳元。敏感性分析结果表明结果是稳健的。
我们的分析支持将服用ACE抑制剂或ARB的HFREF患者转换为沙库巴曲缬沙坦。
