OBJECTIVES: Heart failure (HF) is a clinical syndrome characterized by a reduction in the function of one or both cardiac ventricles. HF was estimated to affect more than 64 million people globally according to the Global Health Data Registry in 2017 leading to reduced quality of life and functional impairment. Sacubitril/valsartan is angiotensin receptor/neprilysin inhibitor (ARNI) that has shown efficacy in HF patients. The aim of this study is to assess the long-term cost and outcomes, considering all direct medical costs of using sacubitril/valsartan compared to enalapril in HFrEF patients from the Egyptian health care system perspective

METHODS: A multi-state Markov model was developed to assess the cost-effectiveness of sacubitril/valsartan vs. ACE-I in the treatment of HFrEF, population. The model utilizes a one-month cycle length and a half-cycle-correction was applied. The model comprises a life-time horizon. The model captures the relationship between CV mortality and HF hospitalization, representing the time dependency of cardiovascular events. The clinical inputs were captured from PARADIGM-HF clinical trial, and all costs were derived from the health insurance organization. Input parameters were validated by Expert Panel. Univariate and probabilistic sensitivity analyses were conducted

RESULTS: All costs and outcomes of sacubitril/valsartan group and SoC group were measured. Sacubitril/valsartan group generates better outcomes at increased costs, resulting in an incremental cost-effectiveness ratio (ICER) of EGP 196,390 per QALY gained (difference in costs; EGP 105,417, difference in outcomes; 0.54). This ICER remains less than the Egyptian cost-effectiveness threshold of EGP 398,439 (3X the gross domestic product per capita). Thus, sacubitril/valsartan compared to SoC is cost-effective treatment in HFrEF patients

CONCLUSIONS: Sacubitril/valsartan compared to SOC lead to improved outcomes in HF patients. It is considered as a cost-effective treatment compared to SOC in HFrEF patients and represents as a good value for the patients, caregivers, society and economy.