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Cost Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective
Objective Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSo...
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Published in: | PharmacoEconomics 2021-11, Vol.39 (11), p.1343-1354 |
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creator | Alsumali, Adnan Djatche, Laurence M Briggs, Andrew Liu, Rongzhe Diakite, Ibrahim Patel, Dipen Wang, Yufei Lautsch, Dominik |
description | Objective
Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective.
Methods
A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor–neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually.
Results
For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to $82,448 per QALY gained.
Conclusions
Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained. |
doi_str_mv | 10.1007/s40273-021-01091-w |
format | article |
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Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective.
Methods
A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor–neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually.
Results
For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to $82,448 per QALY gained.
Conclusions
Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained.</description><identifier>ISSN: 1170-7690</identifier><identifier>EISSN: 1179-2027</identifier><identifier>DOI: 10.1007/s40273-021-01091-w</identifier><identifier>PMID: 34623625</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adults ; Aged ; Angiotensin Receptor Antagonists ; Cardiac output ; Clinical outcomes ; Cost benefit analysis ; Costs ; Diuretics ; Economics ; Ejection fraction ; Health Administration ; Health aspects ; Health Economics ; Heart failure ; Heart Failure - drug therapy ; Heterocyclic Compounds, 2-Ring ; Hospitalization ; Humans ; Markov chains ; Measurement ; Medicare ; Medicine ; Medicine & Public Health ; Methods ; Mortality ; Original ; Original Research Article ; Patients ; Pharmacoeconomics and Health Outcomes ; Prevention ; Public Health ; Pyrimidines ; Quality of Life Research ; Quality-Adjusted Life Years ; Risk factors ; Stroke Volume ; United States</subject><ispartof>PharmacoEconomics, 2021-11, Vol.39 (11), p.1343-1354</ispartof><rights>Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, N.J., U.S.A., Andrew Briggs, Rongzhe Liu, Ibrahim Diakite, Dipen Patel 2021</rights><rights>2021. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, N.J., U.S.A., Andrew Briggs, Rongzhe Liu, Ibrahim Diakite, Dipen Patel.</rights><rights>COPYRIGHT 2021 Springer</rights><rights>Copyright Springer Nature B.V. Nov 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-c4b932b6503bbd94c620a9ff79f2f7fd941fc21249a529c3882e7b92c56a89573</citedby><cites>FETCH-LOGICAL-c541t-c4b932b6503bbd94c620a9ff79f2f7fd941fc21249a529c3882e7b92c56a89573</cites><orcidid>0000-0002-0777-1997 ; 0000-0001-8316-6089 ; 0000-0003-3803-1817 ; 0000-0002-9793-7611 ; 0000-0002-5139-3583 ; 0000-0001-7151-4330</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2582441941/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2582441941?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,11688,27924,27925,36060,36061,44363,74895</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34623625$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alsumali, Adnan</creatorcontrib><creatorcontrib>Djatche, Laurence M</creatorcontrib><creatorcontrib>Briggs, Andrew</creatorcontrib><creatorcontrib>Liu, Rongzhe</creatorcontrib><creatorcontrib>Diakite, Ibrahim</creatorcontrib><creatorcontrib>Patel, Dipen</creatorcontrib><creatorcontrib>Wang, Yufei</creatorcontrib><creatorcontrib>Lautsch, Dominik</creatorcontrib><title>Cost Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective</title><title>PharmacoEconomics</title><addtitle>PharmacoEconomics</addtitle><addtitle>Pharmacoeconomics</addtitle><description>Objective
Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective.
Methods
A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor–neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually.
Results
For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to $82,448 per QALY gained.
Conclusions
Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained.</description><subject>Adults</subject><subject>Aged</subject><subject>Angiotensin Receptor Antagonists</subject><subject>Cardiac output</subject><subject>Clinical outcomes</subject><subject>Cost benefit analysis</subject><subject>Costs</subject><subject>Diuretics</subject><subject>Economics</subject><subject>Ejection fraction</subject><subject>Health Administration</subject><subject>Health aspects</subject><subject>Health Economics</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heterocyclic Compounds, 2-Ring</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Markov chains</subject><subject>Measurement</subject><subject>Medicare</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methods</subject><subject>Mortality</subject><subject>Original</subject><subject>Original Research Article</subject><subject>Patients</subject><subject>Pharmacoeconomics and Health Outcomes</subject><subject>Prevention</subject><subject>Public Health</subject><subject>Pyrimidines</subject><subject>Quality of Life Research</subject><subject>Quality-Adjusted Life Years</subject><subject>Risk factors</subject><subject>Stroke Volume</subject><subject>United 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Andrew</creator><creator>Liu, Rongzhe</creator><creator>Diakite, Ibrahim</creator><creator>Patel, Dipen</creator><creator>Wang, Yufei</creator><creator>Lautsch, Dominik</creator><general>Springer International Publishing</general><general>Springer</general><general>Springer Nature 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Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective</title><author>Alsumali, Adnan ; Djatche, Laurence M ; Briggs, Andrew ; Liu, Rongzhe ; Diakite, Ibrahim ; Patel, Dipen ; Wang, Yufei ; Lautsch, Dominik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-c4b932b6503bbd94c620a9ff79f2f7fd941fc21249a529c3882e7b92c56a89573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adults</topic><topic>Aged</topic><topic>Angiotensin Receptor Antagonists</topic><topic>Cardiac output</topic><topic>Clinical outcomes</topic><topic>Cost benefit analysis</topic><topic>Costs</topic><topic>Diuretics</topic><topic>Economics</topic><topic>Ejection fraction</topic><topic>Health Administration</topic><topic>Health aspects</topic><topic>Health Economics</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heterocyclic Compounds, 2-Ring</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Markov chains</topic><topic>Measurement</topic><topic>Medicare</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methods</topic><topic>Mortality</topic><topic>Original</topic><topic>Original Research Article</topic><topic>Patients</topic><topic>Pharmacoeconomics and Health Outcomes</topic><topic>Prevention</topic><topic>Public Health</topic><topic>Pyrimidines</topic><topic>Quality of Life Research</topic><topic>Quality-Adjusted Life Years</topic><topic>Risk factors</topic><topic>Stroke Volume</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alsumali, Adnan</creatorcontrib><creatorcontrib>Djatche, Laurence M</creatorcontrib><creatorcontrib>Briggs, Andrew</creatorcontrib><creatorcontrib>Liu, Rongzhe</creatorcontrib><creatorcontrib>Diakite, Ibrahim</creatorcontrib><creatorcontrib>Patel, Dipen</creatorcontrib><creatorcontrib>Wang, Yufei</creatorcontrib><creatorcontrib>Lautsch, Dominik</creatorcontrib><collection>SpringerOpen website</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Global News & ABI/Inform Professional</collection><collection>Trade PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>ABI/INFORM Collection</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection</collection><collection>Healthcare Administration Database 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China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>PharmacoEconomics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alsumali, Adnan</au><au>Djatche, Laurence M</au><au>Briggs, Andrew</au><au>Liu, Rongzhe</au><au>Diakite, Ibrahim</au><au>Patel, Dipen</au><au>Wang, Yufei</au><au>Lautsch, Dominik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective</atitle><jtitle>PharmacoEconomics</jtitle><stitle>PharmacoEconomics</stitle><addtitle>Pharmacoeconomics</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>39</volume><issue>11</issue><spage>1343</spage><epage>1354</epage><pages>1343-1354</pages><issn>1170-7690</issn><eissn>1179-2027</eissn><abstract>Objective
Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective.
Methods
A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor–neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually.
Results
For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to $82,448 per QALY gained.
Conclusions
Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>34623625</pmid><doi>10.1007/s40273-021-01091-w</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0777-1997</orcidid><orcidid>https://orcid.org/0000-0001-8316-6089</orcidid><orcidid>https://orcid.org/0000-0003-3803-1817</orcidid><orcidid>https://orcid.org/0000-0002-9793-7611</orcidid><orcidid>https://orcid.org/0000-0002-5139-3583</orcidid><orcidid>https://orcid.org/0000-0001-7151-4330</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adults Aged Angiotensin Receptor Antagonists Cardiac output Clinical outcomes Cost benefit analysis Costs Diuretics Economics Ejection fraction Health Administration Health aspects Health Economics Heart failure Heart Failure - drug therapy Heterocyclic Compounds, 2-Ring Hospitalization Humans Markov chains Measurement Medicare Medicine Medicine & Public Health Methods Mortality Original Original Research Article Patients Pharmacoeconomics and Health Outcomes Prevention Public Health Pyrimidines Quality of Life Research Quality-Adjusted Life Years Risk factors Stroke Volume United States |
title | Cost Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective |
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