Economic evaluation of valsartan in patients with chronic heart failure: results from Val-HeFT adapted to The Netherlands

Summary

The Valsartan Heart Failure Trial (Val-HeFT) was a multinational randomised trial of valsartan versus placebo in a total of 5,010 patients with heart failure. During the study period, valsartan resulted in significant reductions in hospitalisations due to heart failure.

The objective of this study was to evaluate the economic impact of valsartan in Dutch heart failure patients.

Resource use during Val-HeFT was multiplied by Dutch cost estimates. Mean patient follow-up was 23 months and costs for hospitalisations were €617 lower among valsartan patients. Mean total costs for valsartan and placebo patients were €8,810 and €8,441, respectively, resulting in incremental costs of €368. In patients receiving an angiotensin-converting enzyme (ACE) inhibitor but no beta-blocker, these incremental costs were even lower (€171). There were overall net savings of €1,311 in patients not receiving an ACE inhibitor at baseline.

Valsartan provides clinical benefits at modest costs in The Netherlands. In patients not receiving an ACE inhibitor at baseline, valsartan was dominant.     

Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction

Background: Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care.

Aims: To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective.

Methods: A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I–IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril

Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively.

Conclusions: At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering therapy.     

Estimated cost savings associated with the use of valsartan in heart failure in a large US health plan

Summary

Results from a large, randomised clinical trial demonstrated reduced rates of hospitalisation and mortality, and reduced length of stay associated with valsartan added to the usual care of heart failure patients not currently receiving angiotensin-converting enzyme inhibitors (ACEIs). These results were used in a budget impact model for a large US health plan. Administrative claims data were used to estimate cost savings over 1 year. In the study health plan, 63,218 patients were identified with heart failure, with 55% not currently receiving ACEI or valsartan. Using health plan-specific cost data, care for the untreated heart failure patients with valsartan would reduce hospitalisation costs from $135 million to $43 million owing to averted heart failure-related hospitalisations and shortened length of stay for the remaining hospitalisations. Economic effects of other aspects of treatment with valsartan (e.g. outpatient or physician visits or adverse events) were not considered. Taking into account only hospitalisations and the costs of valsartan therapy, net savings in the study health plan would be expected to be $64 million.     

缬沙坦联合葛根素在早期2型糖尿病肾病治疗中的作用

观察缬沙坦联合葛根素在早期2型糖尿病肾病治疗中的临床疗效,探讨缬沙坦联合葛根素在早期2型糖尿病肾病治疗中的作用。依据300 mg/d微量白蛋白排泄率(UAER)≥30 mg/d,选择68例早期2型糖尿病肾病患者,并随机分为2组:观察组和对照组各34例,对照组在常规降糖治疗的基础上,加用缬沙坦胶囊80 mg/d;观察组在对照组治疗的基础上,再加用葛根素400 mg/d。疗程1个月,观察2组患者治疗前后UAER、血清肌酐(Scr)和尿素氮(BUN)等指标。结果为:2组患者治疗后较治疗前,UAER均明显改善,治疗前后差异显著(P0.05);而且观察组治疗后较对照组治疗后UAER下降更明显,两者存在显著性差异(P0.05);2组患者治疗前后比较,Scr和BUN无统计学差异(P0.05)。缬沙坦联合葛根素能较好地降低早期2型糖尿病肾病患者的UAER,更有效地保护肾功能。