Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction
Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction
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DOI：
10.1016/j.jchf.2016.02.007
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发表时间：
2016-05-01
影响因子：
13
通讯作者：
Bellows, Brandon K.
中科院分区：
文献类型：
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作者：
King, Jordan B.;Shah, Rashmee U.;Bellows, Brandon K.
本研究的目的是确定沙库比曲-缬沙坦相对于依那普利治疗射血分数降低的心力衰竭（HFrEF）的成本效益和每质量调整生命年（QALY）获得的成本。降低HFrEF患者的心血管死亡率和心力衰竭住院率。方法采用马尔可夫模型，估计沙库比曲-缬沙坦和依那普利治疗HFrEF的成本、效果和成本-效果。患者进入模型时的年龄为60岁，并从第三方付款人的角度对患者的一生（40年）进行建模。临床概率主要来自PARADIGM-HF（ARNI与ACEI的前瞻性比较，以确定对心力衰竭全球死亡率和发病率的影响）。所有的成本和效果都以每年3%的比率贴现，并以2015年美元表示。结果在基础病例中，沙库比曲-缬沙坦与依那普利相比，终生成本更高（60，391美元对21，758美元），更有效（6.49美元对5.74美元）。沙库比曲，缬沙坦的成本效益是高度依赖于治疗的持续时间，范围从$249，411每QALY在3年到$50，959每QALY获得了在Lifetime.CONCLUSIONS沙库比曲，缬沙坦可能是一个具有成本效益的治疗方案，取决于支付意愿的阈值。未来的研究应结合沙库比曲-缬沙坦的真实证据，以进一步为决策提供信息。(C)2016年由美国心脏病学会基金会。
OBJECTIVES The objective of this study was to determine the cost-effectiveness and cost per quality-adjusted life year (QALY) gained of sacubitril-valsartan relative to enalapril for treatment of heart failure with reduced ejection fraction (HFrEF).BACKGROUND Compared with enalapril, combination angiotensin receptor-neprilysin inhibition (ARNI), as is found in sacubitril-valsartan, reduces cardiovascular death and heart failure hospitalization rates in patients with HFrEF.METHODS Using a Markov model, costs, effects, and cost-effectiveness were estimated for sacubitril-valsartan and enalapril therapies for the treatment of HFrEF. Patients were 60 years of age at model entry and were modeled over a lifetime (40 years) from a third-party payer perspective. Clinical probabilities were derived predominantly from PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). All costs and effects were discounted at a 3% rate annually and are presented in 2015 U.S. dollars.RESULTS In the base case, sacubitril-valsartan, compared with enalapril, was more costly ($60,391 vs. $21,758) and more effective (6.49 vs. 5.74 QALYs) over a lifetime. The cost-effectiveness of sacubitril-valsartan was highly dependent on duration of treatment, ranging from $249,411 per QALY at 3 years to $50,959 per QALY gained over a Lifetime.CONCLUSIONS Sacubitril-valsartan may be a cost-effective treatment option depending on the willingness-to-pay threshold. Future investigations should incorporate real-world evidence with sacubitril-valsartan to further inform decision making. (C) 2016 by the American College of Cardiology Foundation.