[Translated article] Cost-utility of sacubitril/valsartan in heart failure with reduced ejection fraction in Spain.

Introduction: Heart failure is an increasingly common syndrome with a rising prevalence, which associates significant costs, mainly related to hospitalization. In fact, heart failure is the most frequent diagnosis in hospital discharges in Spain.

Objective: To analyze the economic impact of new treatments for heart failure with reduced ejection fraction such as sacubitril/valsartan in out-patient and in-patient setting.

Material and methods: The present economic evaluation study was carried out by developing a Markov model. Treatment with sacubitril/valsartan from admission or after hospital discharge was compared, with enalapril being the comparator. Total costs, years of life gained, quality-adjusted life years, and incremental cost-effectiveness ratio and incremental cost-utility ratio were analyzed. Data were obtained from the PARADIGM-HF and PIONEER-HF studies.

Results: The results of the base cases of the three comparisons made showed that sacubitril/valsartan produced benefits in years of life gained and quality-adjusted life years compared to enalapril showing incremental cost-utility ratio below €20,000/QALY and that this ratio was better in scenarios starting sacubitril/valsartan in the hospital setting once decompensation was resolved.

Conclusion: This study shows that starting sacubitril/valsartan from hospital admission for heart failure is cost-effective from the perspective of the National Health Service in Spain.