Liu Xiao-Qi, He Li-Shan, Huang Jian-Qing, Xiong Ling-Juan, Xia Chen, Lao Hai-Yan
Department of Pharmacy, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Clinical Pharmacy, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.
Heart Fail Rev. 2021 Sep;26(5):1119-1130. doi: 10.1007/s10741-020-09956-6.
The objective of this study was to evaluate the pharmacoeconomic value of sacubitril-valsartan for the treatment of heart failure (HF). PubMed, Embase, Cochrane Library, ScienceDirect, Scopus, CNKI, Wanfang, and VIP databases were searched systematically and the retrieval time ended in August 2019. According to the criteria of inclusion and exclusion, the quality of studies included was evaluated as per the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) scale, and the results were extracted and analyzed systematically. The total of 11 cost-effectiveness studies was identified, 10 were performed in the developed countries and 1 in Thailand. All the patients in the studies had chronic heart failure with reduced ejection fraction (HFrEF). Totally, the quality of all the 11 studies was reported to be of an average score of 20.5. Study perspective and time horizons were described in the 11 studies. All included studies discounted the cost or effectiveness. Only 1 study estimated direct and indirect costs; 10 studies evaluated direct cost. The incremental cost-effectiveness ratio (ICER) of sacubitril-valsartan treating HFrEF was $13,150 per quality-adjusted life-years (QALY) in Thailand and $86,735 in Singapore. In European countries, the ICER was from $21,786 to $34,576 per QALY and mean value was $25,410.6 per QALY. In the USA, ICER values ranged from $47,099 to $143,891 per QALY, and mean value was $73,383.5 per QALY; ICER was $30,090 per QALY in Colombia. With the exception of Thailand and Singapore, the ICER of other countries in the included literature was below the implemented country-specific thresholds. Based on existing literatures, with the exception of Thailand and Singapore, sacubitril-valsartan for the treatment of HFrEF is a better cost-effective therapy with ICER basically below the implemented country-specific thresholds. Sacubitril-valsartan was not considered a cost-effective treatment for heart failure with reduced ejection fraction in Thailand and Singapore with the current economic evaluation evidences, but with the willingness-to-pay (WTP) of other counties, sacubitril-valsartan was found to be a cost-effective treatment compared with comparator. Drug cost, time horizon, and hospitalization were the most influential variables across studies. Four studies indicated that with the longer time horizon, the lower ICER value would gain. Further studies are warranted to better evaluate comprehensive utility value of sacubitril-valsartan on heart failure.
本研究的目的是评估沙库巴曲缬沙坦治疗心力衰竭（HF）的药物经济学价值。系统检索了PubMed、Embase、Cochrane图书馆、ScienceDirect、Scopus、中国知网、万方和维普数据库，检索时间截至2019年8月。根据纳入和排除标准，按照《卫生经济评估报告标准合并版》（CHEERS）量表对纳入研究的质量进行评估，并系统地提取和分析结果。共确定了11项成本效益研究，其中10项在发达国家进行，1项在泰国进行。研究中的所有患者均为射血分数降低的慢性心力衰竭（HFrEF）患者。总体而言，11项研究的质量报告平均得分为20.5分。11项研究中描述了研究视角和时间范围。所有纳入研究均对成本或效果进行了贴现。只有1项研究估计了直接和间接成本；10项研究评估了直接成本。在泰国，沙库巴曲缬沙坦治疗HFrEF的增量成本效益比（ICER）为每质量调整生命年（QALY）13,150美元，在新加坡为86,735美元。在欧洲国家，ICER为每QALY 21,786美元至34,576美元，平均值为每QALY 25,410.6美元。在美国，ICER值为每QALY 47,099美元至143,891美元，平均值为每QALY 73,383.5美元；在哥伦比亚，ICER为每QALY 30,090美元。除泰国和新加坡外，纳入文献中其他国家的ICER均低于实施的国家特定阈值。根据现有文献，除泰国和新加坡外，沙库巴曲缬沙坦治疗HFrEF是一种成本效益较好的治疗方法，ICER基本低于实施的国家特定阈值。根据目前的经济评估证据，在泰国和新加坡，沙库巴曲缬沙坦不被认为是治疗射血分数降低的心力衰竭的成本效益治疗方法，但与其他国家的支付意愿（WTP）相比，沙库巴曲缬沙坦被发现是一种成本效益较好的治疗方法。药物成本、时间范围和住院治疗是各项研究中最具影响力的变量。四项研究表明，时间范围越长，ICER值越低。有必要进行进一步研究，以更好地评估沙库巴曲缬沙坦对心力衰竭的综合效用价值。
