Cost-Effectiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch Pharmacoeconomic Guidelines

• Published in: Value in health 2017-12, Vol.20 (10), p.1260-1269
• Main Authors: Ramos, Isaac Corro, PhD, Versteegh, Matthijs M., PhD, de Boer, Rudolf A., MD, PhD, Koenders, Jolanda M.A., MSc, Linssen, Gerard C.M., MD, PhD, Meeder, Joan G., MD, PhD, Rutten-van Mölken, Maureen P.M.H., PhD
• Format: Article
• Language: English
• Subjects: ACE inhibitor; ACE inhibitors; Adaptation; Aged; Aminobutyrates - economics; Aminobutyrates - therapeutic use; Analysis; Angiotensin Receptor Antagonists - economics; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - economics; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Chronic Disease; Cost analysis; Cost-Benefit Analysis; cost-effectiveness analysis; Decision making; Drug Combinations; Economic models; Economics; Economics, Pharmaceutical; Enalapril - economics; Enalapril - therapeutic use; Enzyme inhibitors; Female; Global health; Guidelines as Topic; Health care expenditures; Heart diseases; Heart failure; Heart Failure - drug therapy; Heart Failure - economics; Humans; Indirect costs; Informal care; Internal Medicine; Male; Middle Aged; Models, Economic; Neprilysin; Neprilysin - antagonists & inhibitors; Netherlands; Patients; Peptidyl-dipeptidase A; Pharmacoeconomics; Pharmacology; Productivity; productivity costs; Quality adjusted life years; Quality of life; Randomized Controlled Trials as Topic; Sensitivity analysis; Stroke Volume - drug effects; Tetrazoles - economics; Tetrazoles - therapeutic use; Ventricle
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.013

Abstract Objectives To describe the adaptation of a global health economic model to determine whether treatment with the angiotensin receptor neprilysin inhibitor LCZ696 is cost-effective compared with the angiotensin-converting enzyme inhibitor enalapril in adult patients with chronic heart failure with reduced left ventricular ejection fraction in the Netherlands; and to explore the effect of performing the cost-effectiveness analyses according to the new pharmacoeconomic Dutch guidelines (updated during the submission process of LCZ696), which require a value-of-information analysis and the inclusion of indirect medical costs of life-years gained. Methods We adapted a UK model to reflect the societal perspective in the Netherlands by including travel expenses, productivity loss, informal care costs, and indirect medical costs during the life-years gained and performed a preliminary value-of-information analysis. Results The incremental cost-effectiveness ratio obtained was €17,600 per quality-adjusted life-year (QALY) gained. This was robust to changes in most structural assumptions and across different subgroups of patients. Probability sensitivity analysis results showed that the probability that LCZ696 is cost-effective at a €50,000 per QALY threshold is 99.8%, with a population expected value of perfect information of €297,128. On including indirect medical costs of life-years gained, the incremental cost-effectiveness ratio was €26,491 per QALY gained, and LCZ696 was 99.46% cost-effective at €50,000 per QALY, with a population expected value of perfect information of €2,849,647. Conclusions LCZ696 is cost-effective compared with enalapril under the former and current Dutch guidelines. However, the (monetary) consequences of making a wrong decision were considerably different in both scenarios.