(J) Economic Evaluation of Sacubitril/Valsartan for The Treatment of Chronic Heart Failure with Reduced Ejection Fraction (HFrEF) in Indonesia

Publication Number: 300

Background: Total costs for cardiovascular diseases reached IDR 18 billion in 2019. Heart failure (HF) is still one of the cardiovascular problems in Indonesia due to the high rate of morbidity, mortality and rehospitalization. PARADIGM-HF trial in 2014 showed that, compared with enalapril, sacubitril/valsartan was associated with a significant reduction in mortality and reduced risk of hospitalization for patients who had heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan has been included in the Indonesia National Formulary for the treatment of HFrEF since 2021

Objectives: Sacubitril/valsartan, a dual-acting angiotensin receptor neprilysin inhibitor (ARNi), is an innovative treatment for HF in patients with HFrEF. This study aimed to analyze the cost-effectiveness of sacubitril/valsartan for the treatment of chronic heart failure with reduced ejection fraction (HFrEF) in Indonesia.

Methods: This economic evaluation considers the cost-effectiveness of intervention of sacubitril/valsartan in addition to standard care vs angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in addition to standard care in the treatment of HFrEF. ACEi is typically used first line in individuals with chronic HFrEF; angiotensin receptor blockers (ARB) may be used where ACEi is not tolerated. An existing excel-based Markov model developed was used to estimate the costs, health outcome and cost-effectiveness ratio of sacubitril/valsartan compared to standard therapy in Indonesian hospital patients. The model run several scenarios varied by the ACEis and ARBs as comparators. Input parameters for model were mainly adopted from PARADIGM-HF Clinical Trials. In addition, country specific data including baseline of population and measurements, costs data, hospitalization and adverse events rates were collected from local data.

Results: Treatment with sacubitril/valsartan resulted higher health outcome (4.048 QALYs) compared to treatment with ACEi (3.648 QALYs). Treatment cost of sacubitril/valsartan was also higher (IDR 182,065,146). Applying ACEis of enalapril, ramipril, perindopril, lisinopril, captopril and ARBs of valsartan, losartan, candesartan in the scenario analysis as comparators to sacubitril/valsartan resulted the highest cost of IDR 160,825,009 (perindopril – losartan) and the lowest cost of IDR 146,429,866 (captopril – valsartan). The ICERs of the scenarios ranged between IDR 57,647,918/QALY to IDR 88,049,523/QALY. Using three times GDP of Indonesia as a cost-effectiveness threshold, the ICERs were considered cost-effective.

Conclusions: Sacubitril/valsartan was cost-effective compared to ACEi or ARBs in addition to standard care in the treatment of chronic HFrEF in Indonesia.