School of Public Health and Preventive Medicine, Monash University, Australia.
Eur J Prev Cardiol. 2021 Aug 9;28(9):966-972. doi: 10.1177/2047487319878953. Epub 2019 Oct 4.
The Comparison of Sacubitril-Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilised from an Acute Heart Failure Episode (PIONEER-HF) trial demonstrated significant reductions in N-terminal pro-B-type natriuretic peptide. Our study explored the cost-effectiveness of the use of sacubitril-valsartan versus enalapril in acute decompensated heart failure from the Australian healthcare perspective.
A Markov model was designed using data from the PIONEER-HF trial to model the clinical progress and costs of patients over a lifetime time horizon. The model consisted of three health states: 'alive and event-free', 'alive after non-fatal hospitalisation for acute decompensated heart failure' or 'dead'. Costs and utilities were estimated from published sources. The cost of sacubitril-valsartan (per the Australian pharmaceutical benefits schedule) was AU$7.08/day. Outcomes of interest were the incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained and cost per year of life saved. Cost and benefits were discounted at 5.0% per annum.
Compared to enalapril, sacubitril-valsartan was estimated to cost an additional AU$7464 (discounted) per person, but lead to 0.127 years of life saved (discounted) and 0.096 quality-adjusted life years gained (discounted) over a lifetime analysis. These equated to incremental cost-effectiveness ratios of AU$58,629/year of life saved (US$41,795, EU€58,629, GBP£32,001) and AU$77,889/quality-adjusted life year gained (US$55,526, EU€49,202, GBP£42,504). We have assumed a threshold of AU$50,000/quality-adjusted life year gained to suggest cost-effectiveness.
At its current acquisition price, sacubitril-valsartan in comparison to enalapril is not likely to be cost-effective in the management of acute decompensated heart failure in Australia. A price reduction of more than 25% would confer cost-effectiveness.
比较沙库巴曲缬沙坦与依那普利对急性心力衰竭稳定后患者对 NT-proBNP 影响的试验（PIONEER-HF 试验）表明，N-末端脑利钠肽前体显著降低。我们的研究从澳大利亚医疗保健的角度探讨了沙库巴曲缬沙坦在急性失代偿性心力衰竭中的使用的成本效益。
使用 PIONEER-HF 试验的数据设计了一个马尔可夫模型，以模拟患者在终生时间范围内的临床进展和成本。该模型由三个健康状态组成：“无事件生存”、“急性失代偿性心力衰竭非致死性住院后生存”或“死亡”。成本和效用来自已发表的来源。沙库巴曲缬沙坦（根据澳大利亚药品福利计划）的费用为每天 7.08 澳元。关注的结果是成本效益比，即每获得一个质量调整生命年的增量成本和每节省一年生命的增量成本。成本和效益以每年 5.0%的速度贴现。
与依那普利相比，沙库巴曲缬沙坦估计每人额外增加 7464 澳元（贴现），但在终生分析中导致 0.127 年的生命节省（贴现）和 0.096 个质量调整生命年的获得（贴现）。这相当于每年节省生命的增量成本效益比为 58629 澳元（41795 美元、58629 欧元、32001 英镑）和每年获得的质量调整生命年的增量成本效益比为 77889 澳元（55526 美元、49202 欧元、42504 英镑）。我们假设一个 50000 澳元/质量调整生命年的阈值，以表明成本效益。
以其目前的收购价格，与依那普利相比，沙库巴曲缬沙坦在澳大利亚急性失代偿性心力衰竭的治疗中不太可能具有成本效益。如果价格降低超过 25%，则具有成本效益。
