Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Am J Cardiovasc Drugs. 2024 May;24(3):445-454. doi: 10.1007/s40256-024-00637-5. Epub 2024 Apr 15.
Vericiguat is a new medication to demonstrate clinical efficacy in heart failure with reduced ejection fraction (HFrEF) after worsening heart failure (WHF) events, but its cost-utility was unknown. We aimed to assess the cost-utility of combining the application of vericiguat with standard treatment in HFrEF patients who had WHF events.
A multistate Markov model was implemented to mimic the economic results of HFrEF patients who had WHF events in China after receiving vericiguat or placebo. An analysis of cost-utility was conducted; most parameters were set according to the published studies and related databases. All the utilities and costs were decreased at a rate of 5% annually. The incremental cost-effectiveness ratios (ICERs) were the primary outcome measure. We also conducted sensitivity analyses.
Over a 20 year lifetime horizon, additional use of vericiguat led to an elevated cost from US$9725.03 to US$20,660.76 at the current vericiguat costs. This was related to increased quality-adjusted life years (QALYs) from 2.50 to 2.66, along with an ICER of US$65,057.24 per QALY, which was over the willingness-to-pay (WTP) threshold of US$36,096.30 per QALY. If the vericiguat costs were discounted at 80%, it contributed to an ICER of US$12,226.77 per QALY. Additional use of vericiguat for patients with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) of ≤ 5314 pg per ml produced an ICER of US$23,688.46 per QALY. The outcomes of the one-way sensitivity analysis showed the risk of death from cardiovascular disease in both groups was variable with the highest sensitivity. The probabilistic sensitivity analysis showed that 41.6% of the mimicked population receiving vericiguat combined with standard therapy was cost-effective at the WTP threshold of US$36,096.30 per QALY.
From the perspective of Chinese public healthcare system, the combined use of vericiguat and standard treatment in patients with HFrEF following WHF events did not generate advantages in cost-utility in China but was a cost-effective therapeutic strategy for those who with plasma NT-proBNP of ≤ 5314 pg per ml.
维立西呱是一种新型药物，可在射血分数降低的心力衰竭（HFrEF）患者发生心力衰竭恶化（WHF）事件后显示临床疗效，但尚不清楚其成本效果。我们旨在评估维立西呱联合 HFrEF 患者 WHF 事件后标准治疗的成本效果。
采用多状态马尔可夫模型模拟中国 WHF 事件后接受维立西呱或安慰剂的 HFrEF 患者的经济结果。进行成本效果分析；大多数参数根据已发表的研究和相关数据库设置。所有效用和成本均按 5%的年增长率降低。增量成本效益比（ICER）是主要的观察指标。我们还进行了敏感性分析。
在 20 年的生命周期内，按照当前维立西呱的成本，额外使用维立西呱会导致成本从 9725.03 美元增加到 20660.76 美元。这与质量调整生命年（QALY）从 2.50 增加到 2.66 有关，同时 ICER 为每 QALY 65057.24 美元，超过了每 QALY 36096.30 美元的意愿支付（WTP）阈值。如果维立西呱的成本打 8 折，ICER 为每 QALY 12226.77 美元。对于血浆 N 末端 B 型利钠肽前体（NT-proBNP）≤5314 pg/ml 的患者，额外使用维立西呱的 ICER 为每 QALY 23688.46 美元。单因素敏感性分析的结果表明，两组心血管疾病死亡风险存在差异，具有最高的敏感性。概率敏感性分析表明，在 WTP 阈值为每 QALY 36096.30 美元的情况下，41.6%接受维立西呱联合标准治疗的模拟人群具有成本效益。
从中国公共医疗保健系统的角度来看，WHF 事件后 HFrEF 患者联合使用维立西呱和标准治疗在成本效果方面没有优势，但对于 NT-proBNP 血浆≤5314 pg/ml 的患者来说，这是一种具有成本效益的治疗策略。
