Hu Tianyang, Liu Yiting, Lou Yake
Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Pharmacol. 2023 Mar 2;14:925375. doi: 10.3389/fphar.2023.925375. eCollection 2023.
The episode of acute decompensated heart failure (ADHF) is the main cause of hospitalization for heart failure (HF). Sacubitril-valsartan has been proven to be effective in reducing the risks of hospitalization for HF in ADHF. When to initiate sacubitril-valsartan in ADHF to make it the most cost-effective in China remains unclear. A lifetime Markov model with a 1-month cycle length was developed to evaluate the cost-effectiveness of early or late initiation of sacubitril-valsartan enalapril in ADHF. Early initiation of sacubitril-valsartan meant that it was initiated after stabilization from ADHF, and late initiation of sacubitril-valsartan meant that it was initiated after stabilization from HF, which includes no hospitalization for at least three consecutive months. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the ratio of incremental cost to incremental effectiveness. The secondary outcomes were total costs and total effectiveness. Three times of GDP of China in 2021 was set as the willingness-to-pay threshold. One-way sensitivity analysis and probabilistic sensitivity analysis were employed to test the robustness of the results. The early initiation of sacubitril-valsartan treatment resulted in an ICER of 3,662.4 USD per quality-adjusted life year, lower than the willingness-to-pay threshold, and the late initiation of sacubitril-valsartan treatment gained an ICER of 4,444.4 USD/QALY, still lower than the willingness-to-pay threshold. One-way sensitivity analysis showed that our results were robust, and probabilistic sensitivity analysis suggested that early initiation of sacubitril-valsartan in ADHF was cost-effective under a 97.4% circumstance. Early initiation of sacubitril-valsartan after stabilization of ADHF is highly cost-effective compared with the use of enalapril; late initiation of sacubitril-valsartan after stabilization of HF is still cost-effective but not as cost-effective as early initiation of sacubitril-valsartan in ADHF. For Chinese ADHF patients, the time to initiate sacubitril-valsartan should be when the patient is stabilized from ADHF rather than when stabilized from HF, from the perspective of economic evaluation.
急性失代偿性心力衰竭（ADHF）发作是心力衰竭（HF）住院的主要原因。沙库巴曲缬沙坦已被证明可有效降低ADHF患者因HF住院的风险。在中国，何时开始使用沙库巴曲缬沙坦以使其最具成本效益尚不清楚。本研究建立了一个周期长度为1个月的终生马尔可夫模型，以评估在ADHF中早期或晚期开始使用沙库巴曲缬沙坦或依那普利的成本效益。早期开始使用沙库巴曲缬沙坦是指在ADHF病情稳定后开始用药，而晚期开始使用沙库巴曲缬沙坦是指在HF病情稳定后开始用药，即至少连续三个月未住院。主要结局是增量成本效益比（ICER），以增量成本与增量效果之比表示。次要结局是总成本和总效果。将2021年中国国内生产总值的三倍设定为支付意愿阈值。采用单向敏感性分析和概率敏感性分析来检验结果的稳健性。早期开始使用沙库巴曲缬沙坦治疗的ICER为每质量调整生命年3662.4美元，低于支付意愿阈值，而晚期开始使用沙库巴曲缬沙坦治疗的ICER为4444.4美元/QALY，仍低于支付意愿阈值。单向敏感性分析表明我们的结果具有稳健性，概率敏感性分析表明在97.4%的情况下，ADHF患者早期开始使用沙库巴曲缬沙坦具有成本效益。与使用依那普利相比，ADHF病情稳定后早期开始使用沙库巴曲缬沙坦具有很高的成本效益；HF病情稳定后晚期开始使用沙库巴曲缬沙坦仍具有成本效益，但不如ADHF患者早期开始使用沙库巴曲缬沙坦那样具有成本效益。从经济学评估的角度来看，对于中国ADHF患者，开始使用沙库巴曲缬沙坦的时机应该是患者从ADHF病情稳定时，而不是从HF病情稳定时。
