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Letters |18 April 2017

Cost-Effectiveness of Sacubitril–Valsartan in Patients Who Have Heart Failure With Reduced Ejection Fraction

Alexander T. Sandhu, MD, MS; Daniel A. Ollendorf, PhD; Richard H. Chapman, PhD; Steven D. Pearson, MD, MSc; Paul A. Heidenreich, MD, MS

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We agree with Dr. King and colleagues about the importance of the multiple cost-effectiveness analyses of sacubitril–valsartan that have been published (1, 2). The consistency in these findings supports the internal validity of these models that were designed using the PARADIGM-HF trial results (3) but does not strengthen the external validity of these results or the likelihood that these estimates will match real-world cost-effectiveness. Given that this combination therapy is novel, data are not sufficient to estimate real-world effectiveness or indication drift. However, we believe that estimating the value of a treatment early in the adoption process is important because these analyses can shape therapy adoption, inform purchasing negotiations (for example, through such evidence reports as those by the California Technology Assessment Forum), and guide the direction of further research needs. In our analysis, we varied important areas of uncertainty in sensitivity analyses and found that these changes did not substantially affect the cost-effectiveness. Nevertheless, we agree that estimates derived from randomized clinical trials may not accurately estimate a therapy's real-world value.
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Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA. Cost-Effectiveness of Sacubitril–Valsartan in Patients Who Have Heart Failure With Reduced Ejection Fraction. Ann Intern Med. ;166:607–608. doi: 10.7326/L17-0044

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Published: Ann Intern Med. 2017;166(8):607-608.

DOI: 10.7326/L17-0044

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2017 American College of Physicians
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