Lower Hospitalization and Total Healthcare Costs Among Patients with Heart Failure When Treated with Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker: A Retrospective Study of Managed Care Claims

• Published in: Heart & lung 2020-03, Vol.49 (2), p.211-211
• Main Authors: Albert, Nancy, Buysman, Erin, Chang, Chunlan, Swindle, Jason
• Format: Article
• Language: English
• ISSN: 0147-9563
• DOI: 10.1016/j.hrtlng.2020.02.012

In the PARADIGM-HF trial, sacubitril/valsartan (SAC/VAL) was superior to enalapril in reducing risks of cardiovascular death and heart failure (HF) hospitalization in patients with HF and reduced ejection fraction (HFrEF); however, there is limited knowledge of the impact of SAC/VAL on real-world clinical outcomes and costs compared to angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB). To compare hospitalization and healthcar e costs among patients with HFrEF treated with SAC/VAL vs. ACEI/ARB. De-identified claims data of adults in a large US managed care health plan (commercial and Medicare Advantage [MA]) were used from Oct 2014 to Sep 2016. Stable patients were identified with claims-based proxy for HFrEF and >=1 claim for SAC/VAL (identified first), ACEI or ARB during Oct 2015 to Jun 2016. Index therapy with >=80% proportion of days covered for first 3 months was required. SAC/VAL and ACEI/ARB cohorts were matched for demographics, baseline characteristics and length of follow-up using propensity scores. Per-patient-per-month (PPPM) hospitalization and healthcare costs (health plan + patient paid amounts) were calculated during a variable follow-up period (3-12 months). Robust variance estimation was used to compare hospitalization and healthcare costs between matched cohorts. Post-match, 279 patients/cohort were identified (mean [SD] age, 67.9 [12.6] years; 73.5% MA enrollee; 68.1% male; 90.9% hypertension; 56.1% diabetes; 46.1% atrial fibrillation; mean (SD) follow-up, 185.0 [70.1] days). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, experienced lower mean (SD) PPPM HF hospitalizations (0.01 [0.06] vs. 0.03 [0.10], p=.003) and all-cause hospitalizations (0.05 [0.11] vs. 0.11 [0.20], p