OBJECTIVES: In the United States (US), patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF) following a worsening HF event (WHFE) have significantly increased medical costs. This analysis aimed to estimate the budget impact of vericiguat as add-on therapy to guideline-directed medical therapy (GDMT) in this population from a US commercial payer perspective.

METHODS: A model was developed to estimate the budget impact of adding vericiguat to the formulary by comparing a current scenario (GDMT) and a new scenario (vericiguat plus GDMT) in a hypothetical 10-million-member commercial health plan over a 3-year time horizon. Epidemiology data was obtained from literature. Utilization rates of GDMT and clinical inputs (HF hospitalization [HFH] and cardiovascular [CV] morality) were based on VICTORIA trial (NCT02861534). Costs (2021 US$) included drug acquisition (RED BOOK), HFH, routine care, and mortality (literature). Dosing was based on prescribing information and VICTORIA.

RESULTS: Approximately 20,510 prevalent cases in year 1 and 3,109 annual incident cases in subsequent years were estimated to be eligible for treatment with vericiguat. At utilization rates of 5%, 10%, and 15% for vericiguat over years 1-3, the annual per-member-per-month (PMPM) budget impact was estimated to be $0.048, $0.064, and $0.086 on total drug acquisition and medical costs. Vericiguat was associated with 44, 32 and 30 fewer HFHs and 7, 12 and 18 fewer CV deaths, respectively over years 1-3, associated with a reduction of the total 3-year budget impact by 14%.

CONCLUSIONS: Adding vericiguat to commercial plan formulary was associated with limited budget impact, primarily driven by drug acquisition costs but partially offset by reduced cost of HFHs and CV deaths.