Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Public Health. 2022 Aug 17;10:959139. doi: 10.3389/fpubh.2022.959139. eCollection 2022.
Sacubitril-valsartan was recommended for heart failure (HF) and proven cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat hypertension by the Chinese expert consensus. The cost utility of sacubitril-valsartan for hypertension remains uninvestigated.
A meta-analysis of randomized controlled trials (RCTs) was performed to investigate the real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor blockers or placebo. A lifetime Markov model was developed to compare the cost utility of sacubitril-valsartan vs. valsartan. The primary outcome was the incremental cost-utility ratio (ICUR), representing the ratio of incremental costs to the incremental utility. The willingness-to-pay (WTP) threshold was three times of per capita gross domestic product (GDP) in China in 2021. Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the WTP threshold, otherwise, sacubitril-valsartanis was not cost-effective.
A total of 10 RCTs of 5,781 patients were included in the meta-analysis. For comparison of sacubitril-valsartan 400 mg/day vs. valsartan 320 mg/day, a reduction in blood pressure (BP) of -5.97 (-6.38, -5.56) ( < 0.01) was observed. Cost-utility analysis showed that for a 60-year-old patient with hypertension, if sacubitril-valsartan was prescribed as the antihypertensive agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALYs) with costs of 65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life expectancy would be 11.82 QALY with costs of 54,769 CNY; thus, an ICUR of 108,622 CNY/QALY was obtained, lower than the WTP threshold.
Compared with valsartan, sacubitril-valsartan is more effective in reducing blood pressure and may result in more quality-adjusted life-year, although with higher costs. Sacubitril-valsartan is cost-effective for hypertension in the current China setting under the willingness-to-pay threshold of 3 times of per capita GDP.
沙库巴曲缬沙坦已被推荐用于心力衰竭（HF）治疗，并已被证明具有成本效益。最近，中国专家共识建议将沙库巴曲缬沙坦用于治疗高血压。然而，沙库巴曲缬沙坦治疗高血压的成本效益仍有待研究。
我们进行了一项随机对照试验（RCT）的荟萃分析，以评估沙库巴曲缬沙坦在降低血压方面的真实疗效，并与血管紧张素受体阻滞剂或安慰剂进行比较。我们构建了一个终生马尔可夫模型，以比较沙库巴曲缬沙坦与缬沙坦的成本效益。主要结局指标是增量成本效用比（ICUR），表示增量成本与增量效用的比值。意愿支付（WTP）阈值为 2021 年中国人均国内生产总值（GDP）的三倍。如果获得的 ICUR 低于 WTP 阈值，则认为沙库巴曲缬沙坦具有成本效益，否则认为沙库巴曲缬沙坦不具有成本效益。
共有 10 项 RCT 纳入了 5781 名患者。与缬沙坦 320mg/d 相比，沙库巴曲缬沙坦 400mg/d 可使血压降低-5.97（-6.38，-5.56）（<0.01）。成本效用分析显示，对于一名 60 岁的高血压患者，如果处方沙库巴曲缬沙坦作为降压药，其预期寿命为 11.91 个质量调整生命年（QALY），成本为 65066 元人民币；如果处方缬沙坦作为降压药，预期寿命为 11.82 QALY，成本为 54769 元人民币；因此，ICUR 为 108622 元人民币/QALY，低于 WTP 阈值。
与缬沙坦相比，沙库巴曲缬沙坦在降低血压方面更有效，尽管成本更高，但可能带来更多的质量调整生命年。在中国当前的支付意愿阈值下，沙库巴曲缬沙坦治疗高血压具有成本效益。
