From the Guidelines
Entresto (sacubitril/valsartan) has a cost per year of life saved for heart failure with reduced ejection fraction of approximately $45,017 per QALY, as demonstrated in a recent study published in the Journal of the American College of Cardiology 1. This cost-effectiveness is comparable to other high-value cardiovascular interventions, such as implantable cardioverter-defibrillator, percutaneous coronary intervention, and left ventricular assist device. The medication's ability to significantly reduce cardiovascular mortality and heart failure hospitalizations, as well as improve quality of life and extend survival, justifies its higher acquisition cost compared to older heart failure medications. Some key points to consider when evaluating the cost-effectiveness of Entresto include:
- The incremental cost-effectiveness ratio (ICER) of $45,017 per QALY, which is within the range of reasonable ICER thresholds for cardiology interventions ($50,000 to $100,000 per QALY) as stated by the American College of Cardiology and American Heart Association 1.
- The cost-effectiveness of Entresto is consistent with high-value cardiovascular interventions, and its use is supported by the 2022 ACC/AHA/Heart Failure Society of America clinical practice guidelines 1.
- While Entresto may contribute to financial burden and toxicity for individual patients, its cost-effectiveness is measured at a health systems level and is considered a high-value treatment with reasonable cost-effectiveness 1.
From the Research
Cost-Effectiveness of Entresto for Heart Failure with Reduced EF
- The cost-effectiveness of sacubitril/valsartan (Entresto) in the treatment of heart failure with reduced ejection fraction (HFrEF) has been evaluated in several studies 2, 3, 4.
- A study published in the Heart journal found that the cost per quality-adjusted life-year (QALY) gained for sacubitril/valsartan was £17,100 (€20,400) in the UK, Kr 174,000 (€22,600) in Denmark, and COP$39.5 million (€11,200) in Colombia 2.
- Another study published in the Swiss medical weekly journal found that the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan was CHF 25,684 per QALY gained, with a probability of being cost-effective at a threshold of CHF 50,000 per QALY gained of 99.0% 3.
- A cost-effectiveness analysis published in the Journal of cardiovascular medicine found that sacubitril/valsartan was dominant (cost-saving and clinically superior) compared to an implantable cardioverter-defibrillator (ICD) in patients with HFrEF, with an incremental cost-effectiveness ratio of -€98,500 per QALY gained 4.
Cost per Year of Life Saved
- The cost per year of life saved for Entresto can be estimated based on the ICER values reported in the studies.
- Assuming an ICER of £17,100 per QALY gained in the UK, and an average life expectancy gain of 0.5 years per QALY gained, the cost per year of life saved would be approximately £34,200 per year of life saved.
- Similarly, based on the ICER values reported in the other studies, the cost per year of life saved would be approximately €45,200 per year of life saved in Denmark, €22,400 per year of life saved in Colombia, and -€197,000 per year of life saved (dominant) in the comparison with ICD.