Economic Evaluation of Sacubitril/Valsartan in Chronic Heart Failure Patients: A Markov Model Analysis in Iran

Mahmood  Yousefi; Fatemeh  Keshvari-Shad; Farhad  Khalili; Jebraeil  Farzi; Baharak  Aghapour; Maryam  Chenaghlou

doi:10.18502/htaa.v9i4.20662

Mahmood Yousefi Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Fatemeh Keshvari-Shad Sina (Farshchian) Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
Farhad Khalili Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran.
Jebraeil Farzi Department of Health Information Technology, School of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol, Iran.
Baharak Aghapour Department of Community Nutrition, School of Nutrition and Food Sciences, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Maryam Chenaghlou Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

DOI: https://doi.org/10.18502/htaa.v9i4.20662

Keywords: Cost-utility analysis, Markov model, Heart failure with reduced ejection fraction, Sacubitril/valsartan

Abstract

Background: Sacubitril/valsartan (Sac-Val) is recommended for patients with heart failure (HF) and reduced ejection fraction (HFrEF). This study aimed to evaluate the cost-effectiveness of Sac/Val in chronic HF patients in Iran.

Methods: A Markov model was constructed to assess the cost-effectiveness of Sac/Val and enalapril from a healthcare perspective over a 15-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY). A discount rate of 3.5% was applied to both costs and outcomes, and a probabilistic sensitivity analysis was performed to evaluate the robustness of the results.

Results: The average costs of treating HF patients with Sac/Val and enalapril were 22,132,050,140 IRR (USD 77,442.3) and 143,043,859 IRR (USD 500.52), respectively, whereas the corresponding QALY values were 5.37 and 3.30, respectively. Sac/Val was more expensive and more effective than enalapril. The ICER was 10,635,189,214 IRR per QALY (37.06 USD/QALY), which was higher than the WHO- recommended threshold in terms of gross domestic product per capita in 2022. Sac/Val had a significant impact on increasing the QALY for HFrEF patients. At the proposed price, the cost per QALY value for Sac/Val exceeded the recommended threshold for the country.

Conclusion: Considering the country’s economic context, negotiating lower prices for Sac/Val would bring it to the top of the priority list for health services.