Cost-effectiveness in unstable economies: the case of sacubitril/valsartan in heart failure with reduced ejection fraction in Argentina

Health Economics Review

Research

Carlos P. Boissonnet¹  Mariano A. Giorgi²  Sergio Volman³  Fernanda Ditata³  Carlos Porley³  Paula Soledad Luque³  Jimena Piastrella⁴ 

[1] Health Economics and Technology Assessment Unit. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Instituto Universitario CEMIC (IUC), Buenos Aires, Argentina;Cardiology Section. Department of Internal Medicine. Centro de Educación Médica e Investigaciones Clínicas, Norberto Quirno” (CEMIC), Buenos Aires, Argentina;Health Economics and Technology Assessment Unit. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Instituto Universitario CEMIC (IUC), Buenos Aires, Argentina;Cardiology Section. Department of Internal Medicine. Centro de Educación Médica e Investigaciones Clínicas, Norberto Quirno” (CEMIC), Buenos Aires, Argentina;Associate Professor of Pharmacology, Instituto Universitario CEMIC (IUC), Buenos Aires, Argentina;Novartis Pharmaceutilcals, Basel, Switzerland;Piastrella Worked at Novartis at the Time This Research Was Conducted, Basel, Switzerland;

关键词: Cost-effectiveness;    Heart failure;    Discount rate;   

DOI  :  10.1186/s13561-023-00427-w

 received in 2022-03-31, accepted in 2023-02-13,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSacubitril/valsartan (an Angiotensin receptor-neprilysin inhibitor—ARNI) is one of the cornerstones in the management of patients with heart failure with reduced ejection fraction (HFrEF) having demonstrated significant reductions in both mortality and hospitalisations as compared with enalapril. It proved to be a cost-effective treatment in many countries with stable economies. In Argentina, a country with chronic financial instability and a fragmented health care system, the estimation of its cost-effectiveness requires to consider local financial data.ObjectivesTo estimate the cost-effectiveness of sacubitril/valsartan in HFrEF in Argentina.MethodsWe populated an Excel-based cost-effectiveness model, previously validated, using inputs from the pivotal phase-3 PARADIGM-HF trial and from local sources. As the main problem to consider was the financial instability, we adopted a differential approach to cost discounting based on the opportunity cost of capital. Thus, a discount rate for costs were set at 31.6%, using the BADLAR rate published by the Central Bank of Argentina. Discount for effects were set at 5% as is the current practice. Costs were expressed in Argentinian pesos (ARS). We used the perspective for both the social security and private payers at a 30-year horizon. The primary analysis was the incremental cost-effectiveness ratio (ICER) versus enalapril, the previous standard of care. Alternative scenarios performed included a 5% cost discount rate and 3 a 5-year horizon (as is usually used).ResultsIn Argentina the cost-per quality adjusted life-year (QALY) gained for sacubitril/valsartan versus enalapril was 391,158 ARS and 376,665 ARS for a social security and a private payer, respectively, at a 30- year horizon. These ICERs were under the cost- effectiveness threshold of 520,405.79 ARS (1 Gross domestic product (GDP) per capita) suggested by Argentinian health technology assessment bodies. Probabilistic sensitivity analysis showed an acceptability of sacubitril/valsartan as a cost-effective alternative of 86.40% and 88.25% for social security and private payers, respectively.ConclusionSacubitril/valsartan is a cost-effective treatment in HFrEF using local inputs that considered the financial instability. For both payers considered the cost per QALY gained are under the cost-effectiveness threshold considered.

【 授权许可】

CC BY   
© The Author(s) 2023

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