Vericiguat versus sacubitril/valsartan for the treatment of heart failure with reduced ejection fraction in China: a cost-utility analysis.

BACKGROUND

PARADIGM-HF and VICTORIA studies have shown that treatment with sacubitril/valsartan or vericiguat could reduce cardiovascular mortality and hospitalisation in the patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the cost-utility analysis of adding sacubitril/valsartan or vericiguat to the standard treatment of heart failure in Chinese patients with HFrEF was still unclear.

METHODS

Based on the Chinese healthcare system, a multi-state Markov model has been established for the cost-utility analysis and compared with the results of VICTORIA study subgroups and relevant local data in China. This model simulated the direct medical costs and quality-adjusted life years (QALYs) of HFrEF patients over a period of 20 years, in which these patients were treated with the standard treatment of heart failure and either adding sacubitril/valsartan or vericiguat. Moreover, incremental cost-utility ratio (ICUR) and incremental net monetary benefit (INMB) were also analysed and the robustness of the results was verified by using sensitivity analysis.

RESULTS

In the base case study, according to the Chinese HFrEF patients, the total costs for the sacubitril/valsartan group and the vericiguat group were 4,237.42 USD and 4,618.59 USD, respectively, and the total utility was 3.62 and 3.48 QALYs, respectively. The ICUR was -2,611.68 USD/QALY, and the INMB was -5,772.32 USD. The sensitivity analysis indicated that the results were robust. The results of scenario analysis and base-case analysis were basically consistent.

CONCLUSIONS

On the standard treatment of heart failure, adding sacubitril/valsartan alone was more cost-effective than adding vericiguat alone for the treatment of HFrEF.