Abstract

Van der Pol et al¹ present a decision model that assesses the cost-effectiveness of sacubitril/valsartan compared with both enalapril and candesartan (plus concomitant therapy in each arm) for patients with heart failure in Germany. To this end, the authors apply the efficiency-frontier (EF) method, which was developed by the German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen [IQWiG]) to inform negotiations on reimbursement prices in the German social health insurance system (according to §130b (8) Sentence 3 Social Code - Book V). To apply the EF method, the IQWiG needs to be commissioned by the German Federal Joint Committee (Gemeinsamer Bundesausschuss).
Van der Pol et al¹ now present a puzzling piece that seems to challenge the applicability of the IQWiG’s EF method in the case of the drug combination sacubitril/valsartan for the treatment of heart failure. According to the authors, the problem appears because the comparator of sacubitril/valsartan, which is enalapril, dominates its comparators, i.e., candesartan and placebo (all comparators are add-on to background therapy). Regarding other approved drugs for heart failure such as diuretics and beta-blockers, the authors state that “these treatments cannot really be considered true alternatives in the context of the EF and were therefore not included as comparators to sacubitril/valsartan.”¹