Cost-Effectiveness of Sacubitril/Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review

To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF). A systematic literature search was conducted searching in major electronic databases from inception to January 1, 2021. All relevant full economic evaluation...

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Published in:Journal of Tehran University Heart Center 2022-10, Vol.17 (4), p.168-179
Main Authors: Rezapour, Aziz, Azari, Samad, Arabloo, Jalal, Kolivand, Pirhossein, Behzadifar, Masoud, Omidi, Negar, Sarabi Asiabar, Ali, Saberian, Peyman, Pourasghari, Hamid, Bragazzi, Nicola Luigi, Mehrani, Mehdi, Shahi, Shayan, Tajdini, Masih
Format: Article
Language:English
Subjects:
Congestive heart failure
Cost analysis
Cost-effectiveness analysis
Costs
Developing countries
Effectiveness
Heart failure
Heart Failure
epidemiology
Heart Failure
therapy
LDCs
Literature reviews
Mortality
Patients
Review
Sacubitril-valsartan
Search methods
Systematic review
Citations: Items that cite this one
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Summary:To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF). A systematic literature search was conducted searching in major electronic databases from inception to January 1, 2021. All relevant full economic evaluation studies of sacubitril/valsartan versus enalapril for the treatment of patients with HFrEF were identified using ad hoc search strategies. Mortality, hospital admissions, quality-adjusted life years (QALYs), life-years (LYQs), annual drug costs, total lifetime costs, and incremental cost-effectiveness ratio (ICER) were considered as the outcomes. The quality of the included studies was assessed using the CHEERS checklist. This study was conducted and reported in accordance with the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. The initial search yielded a pool of 1026 articles, of which 703 unique articles were screened, 65 full-text articles were assessed for eligibility and 15 studies finally included in the qualitative synthesis. Studies show that sacubitril/valsartan reduces mortality and hospitalization rate. The mean of death risk ratio and hospitalization were computed at 0.843 and 0.844, respectively. Sacubitril/valsartan produced higher annual and total lifetime costs. The lowest and highest lifetime costs for sacubitril/valsartan were found in Thailand ($4,756) and Germany ($118,815), respectively. The lowest ICER was reported in Thailand ($4857/QALY) and the highest in the USA ($143,891/QALY). Sacubitril/valsartan is associated with better outcomes and may be cost-effective compared to enalapril for the management of HFrEF. However, in developing countries such as Thailand, sacubitril-valsartan costs must be reduced to yield an ICER below the threshold.
ISSN:1735-5370
1735-8620
2008-2371
DOI:10.18502/jthc.v17i4.11603