Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 147 No. 4546 (2017)

Cost-effectiveness of sacubitril/valsartan in chronic heart-failure patients with reduced ejection fraction

  • Zanfina Ademi
  • Alena M Pfeil
  • Elizabeth Hancock
  • David Trueman
  • Rola Haroun
  • Céline Deschaseaux
  • Matthias Schwenkglenks
Cite this as:
Swiss Med Wkly. 2017;147:w14533



We aimed to assess the cost effectiveness of sacubitril/valsartan compared to angiotensin-converting enzyme inhibitors (ACEIs) for the treatment of individuals with chronic heart failure and reduced-ejection fraction (HFrEF) from the perspective of the Swiss health care system.


The cost-effectiveness analysis was implemented as a lifelong regression-based cohort model. We compared sacubitril/valsartan with enalapril in chronic heart failure patients with HFrEF and New York-Heart Association Functional Classification II–IV symptoms. Regression models based on the randomised clinical phase III PARADIGM-HF trials were used to predict events (all-cause mortality, hospitalisations, adverse events and quality of life) for each treatment strategy modelled over the lifetime horizon, with adjustments for patient characteristics. Unit costs were obtained from Swiss public sources for the year 2014, and costs and effects were discounted by 3%. The main outcome of interest was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life years (QALYs) gained. Deterministic sensitivity analysis (DSA) and scenario and probabilistic sensitivity analysis (PSA) were performed.


In the base-case analysis, the sacubitril/valsartan strategy showed a decrease in the number of hospitalisations (6.0% per year absolute reduction) and lifetime hospital costs by 8.0% (discounted) when compared with enalapril. Sacubitril/valsartan was predicted to improve overall and quality-adjusted survival by 0.50 years and 0.42 QALYs, respectively. Additional net-total costs were CHF 10 926. This led to an ICER of CHF 25 684. In PSA, the probability of sacubitril/valsartan being cost-effective at thresholds of CHF 50 000 was 99.0%.


The treatment of HFrEF patients with sacubitril/valsartan versus enalapril is cost effective, if a willingness-to-pay threshold of CHF 50 000 per QALY gained ratio is assumed.


  1. Roger VL. Epidemiology of heart failure. Circ Res. 2013;113(6):646–59. doi:.
  2. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al.; American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44. doi:.
  3. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41. doi:.
  4. Edelmann F. Epidemiologie und Prognose der Herzinsuffizienz [Epidemiology and prognosis of heart failure]. Herz. 2015;40(2):176–84. Article in German. doi:.
  5. Owens AT, Jessup M. The year in heart failure. J Am Coll Cardiol. 2012;60(5):359–68. doi:.
  6. Hoekstra T, Jaarsma T, van Veldhuisen DJ, Hillege HL, Sanderman R, Lesman-Leegte I. Quality of life and survival in patients with heart failure. Eur J Heart Fail. 2013;15(1):94–102. doi:.
  7. Rustøen T, Stubhaug A, Eidsmo I, Westheim A, Paul SM, Miaskowski C. Pain and quality of life in hospitalized patients with heart failure. J Pain Symptom Manage. 2008;36(5):497–504. doi:.
  8. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al.; Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803–69. doi:.
  9. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al.; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. doi:.
  10. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al.; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993–1004. doi:.
  11. McMurray JJ, Cowie MR, Cohen AA, Briggs A, de Pouvourville G, Taylor M, et al. A New Cost-Effectiveness Modelling Approach In Chronic Heart Failure With Reduced Ejection Fraction. Value Health. 2015;18(7):A394. doi:.
  12. Solomon SD, Claggett B, Desai AS, Packer M, Zile M, Swedberg K, et al. Influence of Ejection Fraction on Outcomes and Efficacy of Sacubitril/Valsartan (LCZ696) in Heart Failure with Reduced Ejection Fraction: The Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial. Circ Heart Fail. 2016;9(3):e002744. doi:.
  13. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al.; PARADIGM-HF Committees and Investigators. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur J Heart Fail. 2013;15(9):1062–73. doi:.
  14. Swiss Federal Statistical Office S. Ständige Wohnbevölkerung nach Alter, Geschlecht 2013 [cited 2015 March 11]. Available from:
  15. Swiss Federal Statistical Office S. Sterbefälle und Sterbeziffern wichtiger Todesursachen, nach Alter, Geschlecht 2012 [cited 2015 March 11]. Available from:
  16. Dolan P, Roberts J. Modelling valuations for Eq-5d health states: an alternative model using differences in valuations. Med Care. 2002;40(5):442–6. doi:.
  17. Swiss Heart Failure Working Group of the Swiss Society of Cardiology S. Diagnose und Behandlung der chronischen Herzinsuffizienz. www.heartfailure.ch2013.
  18. Muntwyler J, Follath F. [Medical treatment of heart failure: an analysis of actual treatment practices in outpatients in Switzerland. The Swiss “IMPROVEMENT of HF” Group]. Schweiz Med Wochenschr. 2000;130(34):1192–8. Article in German.
  19. Federal Office of Public Health F. Spezialitätenliste (SL) 2015 [cited 2015 March 11]. Available from:
  20. Swiss Federal Statistical Office S. Fallkostenstatistik 2012 - Kosten pro Fall nach SwissDRG 2012 [cited 2015 March 22]. Available from:
  21. Swiss Federal Statistical Office S. Landesindex der Konsumentenpreise (LIK) - Gesundheitspflege 2014 [cited 2015 March 24]. Available from:
  22. Federal Office of Public Health F. Analysenliste (AL) 2015 [cited 2015 March 11]. Available from:
  23. Brändle M, Goodall G, Erny-Albrecht KM, Erdmann E, Valentine WJ. Cost-effectiveness of pioglitazone in patients with type 2 diabetes and a history of macrovascular disease in a Swiss setting. Swiss Med Wkly. 2009;139(11-12):173–84.
  24. Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making. 2000;20(3):332–42. doi:.
  25. McCabe C, Claxton K, Culyer AJ. The NICE cost-effectiveness threshold: what it is and what that means. Pharmacoeconomics. 2008;26(9):733–44. doi:.
  26. Swiss Federal Court decision 9C 334/2010, dated November 23rd, 2010.
  27. Gaziano TA, Fonarow GC, Claggett B, Chan WW, Deschaseaux-Voinet C, Turner SJ, et al. Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction. JAMA Cardiol. 2016;1(6):666–72. doi:.
  28. King JB, Shah RU, Bress AP, Nelson RE, Bellows BK. Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2016;4(5):392–402. doi:.
  29. Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA. Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction. Ann Intern Med. 2016;165(10):681–9. doi:.
  30. van der Pol S, Degener F, Postma MJ, Vemer P. An Economic Evaluation of Sacubitril/Valsartan for Heart Failure Patients in the Netherlands. Value Health. 2017;20(3):388–96. doi:.
  31. Borowiec L, Faluta T, Filipiak KJ, Niewada M, Wrona W. Cost-effectiveness analysis of ivabradine in chronic heart failure in the polish setting. Value Health. 2013;16(7):A528–9. doi:.
  32. Soto H, Pizarro M, Botello BS, Almeida E. Cost effectiveness and cost utility analyses of ivabradine (procoralan) in the treatment of patients with chronic heart failure in mexico. Value Health. 2013;16(3):A286. doi:.
  33. Kourlaba G, Parissis J, Karavidas A, Beletsi A, Milonas C, Maniadakis N. Economic evaluation of ivabradine in chronic heart failure in Greece. Value Health. 2013;16(7):A524. doi:.
  34. Ergene O, Oto A, Cavusoglu Y, Aydogdu S, Ozdemir O, Tan M. A Cost-Effectiveness Analysis of Coralan (Ivabradine) Plus Standard Care Versus Standard Care Alone in Chronic Heart Failure. Value Health. 2012;15(7):A372. doi:.
  35. Lacey L, McAuliffe A, Poisson M. Economic evaluation of ivabradine for chronic heart failure NYHA II to IV class with systolic dysfunction in Ireland. Value Health. 2013;16(7):A527. doi:.
  36. Mihajlovic J, Brkic D, Seferovic P, Sakac D, Zivkov-Saponja D, Ponjevic I. Cost effectiveness of ivabradine in heart failure patients-an analysis from Serbian perspective. Eur J Heart Fail Suppl. 2012;11:S153.
  37. Chang CJ, Chu PH, Fann CSJ. Cost Effectiveness Of Ivabradine In Chronic Heart Failure Patients With Heart Rate Above Bpm In Taiwan. Value Health. 2014;17(7):A488. doi:.
  38. Griffiths A, Paracha N, Davies A, Branscombe N, Cowie MR, Sculpher M. The cost effectiveness of ivabradine in the treatment of chronic heart failure from the U.K. National Health Service perspective. Heart. 2014;100(13):1031–6. doi:.
  39. Jhund PS, Fu M, Bayram E, Chen CH, Negrusz-Kawecka M, Rosenthal A, et al.; PARADIGM-HF Investigators and Committees. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J. 2015;36(38):2576–84. doi:.
  40. Heran BS, Musini VM, Bassett K, Taylor RS, Wright JM. Angiotensin receptor blockers for heart failure. Cochrane Database Syst Rev. 2012;4(4):CD003040.
  41. Chevalier J, de Pouvourville G. Valuing EQ-5D using time trade-off in France. Eur J Health Econ. 2013;14(1):57–66. doi:.
  42. Greiner W, Claes C, Busschbach JJV, von der Schulenburg JM. Validating the EQ-5D with time trade off for the German population. Eur J Health Econ. 2005;6(2):124–30. doi:.
  43. Agvall B, Borgquist L, Foldevi M, Dahlström U. Cost of heart failure in Swedish primary healthcare. Scand J Prim Health Care. 2005;23(4):227–32. doi:.

Most read articles by the same author(s)

1 2 > >>