Kuan Wai Chee, Ademi Zanfina, Lee Sit Wai, Ong Siew Chin, Chee Kok Han, Kasim Sazzli, Raja Shariff Raja Ezman, Mohd Ghazi Azmee, Abdul Kader Muhamad Ali S K, Lim Ka Keat, Shetty Siddesh, Fox-Rushby Julia, Dujaili Juman, Lee Kenneth Kwing-Chin, Teoh Siew Li
School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia.
Health Economics and Policy Evaluation Research (HEPER) group, Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.
Value Health Reg Issues. 2025 May 3;48:101118. doi: 10.1016/j.vhri.2025.101118.
This study compared the costs and effectiveness of angiotensin receptor neprilysin inhibitor (ARNI) with angiotensin-converting enzyme inhibitor (ACEI) for the heart failure with reduced ejection fraction population from the Malaysian Ministry of Health's perspective.
A 3-state Markov model, with a monthly cycle, was constructed to estimate the lifetime healthcare costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) of ARNI and ACEI. The monthly baseline risks for all-cause mortality and heart failure (HF) hospitalization were estimated from the PARADIGM-HF trial and age-adjusted to the Malaysian population. The treatment effects were obtained from the PARADIGM-HF trial. All-cause mortality risks from hospitalization, utility values, and costs were derived from local studies. All costs were adjusted to 2023. The ICER was compared with Malaysian Ringgit (RM) 55 426 per QALY (one gross domestic product per capita).
Despite ARNI being more expensive compared with ACEI, it gained more QALYs, resulting in an ICER of RM46 498 per QALY. One-way sensitivity analyses found that the key model drivers were the relative treatment effects on cardiovascular mortality, duration of treatment effects, and time horizon. Probabilistic sensitivity analysis estimated that ARNI is 66% cost-effective at the cost-effectiveness threshold of RM55 426 per QALY. Subgroup analysis showed that ICER increased with age. Scenario analysis demonstrated that initiation of ARNI alongside sodium-glucose cotransporter-2 inhibitor (SGLT-2i) produces more favorable ICER and ARNI without SGLT-2i.
At the cost-effectiveness threshold of RM55 426 per QALY, ARNI is cost-effective compared with ACEI for the heart failure with reduced ejection fraction population. Expanding patient access to ARNI is likely to improve health outcomes cost-effectively.
本研究从马来西亚卫生部的角度，比较了血管紧张素受体脑啡肽酶抑制剂（ARNI）与血管紧张素转换酶抑制剂（ACEI）用于射血分数降低的心力衰竭人群的成本和效果。
构建了一个每月循环的三状态马尔可夫模型，以估计ARNI和ACEI的终身医疗保健成本、质量调整生命年（QALY）和增量成本效益比（ICER）。全因死亡率和心力衰竭（HF）住院的每月基线风险根据PARADIGM-HF试验进行估计，并根据马来西亚人群进行年龄调整。治疗效果来自PARADIGM-HF试验。住院全因死亡风险、效用值和成本来自当地研究。所有成本均调整至2023年。将ICER与每QALY 55426马来西亚林吉特（RM）（人均国内生产总值）进行比较。
尽管ARNI比ACEI更昂贵，但它获得了更多的QALY，导致每QALY的ICER为RM46498。单向敏感性分析发现，关键模型驱动因素是对心血管死亡率的相对治疗效果、治疗效果持续时间和时间范围。概率敏感性分析估计，在每QALY RM55426的成本效益阈值下，ARNI具有66%的成本效益。亚组分析表明，ICER随年龄增加而增加。情景分析表明，ARNI与钠-葡萄糖协同转运蛋白-2抑制剂（SGLT-2i）联合使用产生的ICER比不使用SGLT-并使用ARNI更有利。
在每QALY RM55426的成本效益阈值下，对于射血分数降低的心力衰竭人群，ARNI与ACEI相比具有成本效益。扩大患者获得ARNI的机会可能会以具有成本效益的方式改善健康结果。
