Dept. Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin, 8, Ireland.
Medicines Management Programme, Health Service Executive, St. James' Hospital, Dublin, 8, Ireland.
Br J Clin Pharmacol. 2021 Feb;87(2):406-413. doi: 10.1111/bcp.14393. Epub 2020 Jun 12.
Entresto (sacubitril/valsartan) is used to treat symptomatic chronic heart failure with reduced ejection fraction. Given its high potential budget impact, the Health Services Executive introduced a reimbursement application system (RAS) to ensure its appropriate use. The aim of this study was to evaluate the utilisation of Entresto in Ireland and compare patient characteristics to those of the pivotal PARADIGM-HF trial.
We used dispensed claims data from the Primary Care Reimbursement Services, clinical data obtained from the RAS, and data from published studies of Entresto utilisation. Differences in the baseline characteristics in the study populations vs the Entresto arm of the PARADIGM-HF trial were analysed. We also investigated cardiovascular medication use in the 6 months pre- and post-Entresto initiation.
In 2018, there were 1043 individuals receiving Entresto, corresponding to an expenditure of €1.2 million. Patients prescribed Entresto in Ireland were older, had lower left ventricular ejection fraction and were more symptomatic than those in the PARADIGM-HF trial. Irish patient characteristics were reflective of Entresto-treated populations in other real-world studies. More than 63% of patients were commenced on the lowest Entresto dose. Entresto initiation was associated with a reduction in the use of other medications for heart failure.
The utilisation of Entresto has been steadily increasing in Ireland since its reimbursement approval. The expenditure in the first year was substantially lower than predicted, and the RAS is an example of how health technology management can facilitate appropriate and cost-effective use of medicines.
Entresto（沙库巴曲缬沙坦）用于治疗射血分数降低的有症状慢性心力衰竭。鉴于其潜在的高额预算影响，卫生服务执行局引入了报销申请系统（RAS）以确保其合理使用。本研究旨在评估 Entresto 在爱尔兰的使用情况，并将患者特征与关键 PARADIGM-HF 试验进行比较。
我们使用初级保健报销服务的配药数据、从 RAS 获得的临床数据以及 Entresto 使用的已发表研究数据。分析研究人群与 PARADIGM-HF 试验中 Entresto 组之间的基线特征差异。我们还调查了 Entresto 起始前后 6 个月心血管药物的使用情况。
2018 年，有 1043 人接受 Entresto 治疗，支出为 120 万欧元。爱尔兰开处方 Entresto 的患者比 PARADIGM-HF 试验中的患者年龄更大，左心室射血分数更低，症状更严重。爱尔兰患者的特征反映了其他真实世界研究中接受 Entresto 治疗的人群。超过 63%的患者接受了最低剂量的 Entresto。Entresto 的起始与心力衰竭其他药物使用的减少相关。
自报销批准以来，Entresto 在爱尔兰的使用稳步增加。第一年的支出远低于预期，RAS 是卫生技术管理如何促进药物合理和具有成本效益使用的一个范例。
