{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T19:37:58Z","timestamp":1780429078509,"version":"3.54.1"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T00:00:00Z","timestamp":1524614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["5R25 CA057699"],"award-info":[{"award-number":["5R25 CA057699"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2018,5]]},"abstract":"Objective<\/jats:title>Sacubitril\/valsartan (SAC<\/jats:styled-content>\/VAL<\/jats:styled-content>) has been shown to reduce mortality and hospitalization in patients with heart failure with reduced ejection fraction (HF<\/jats:styled-content>rEF<\/jats:styled-content>) compared with enalapril but at a substantially higher cost. This study evaluates the cost\u2010effectiveness of SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> versus enalapril in patients with HF<\/jats:styled-content>rEF<\/jats:styled-content> over a 5\u2010year time horizon from the U.S. payer perspective.<\/jats:p><\/jats:sec>Methods<\/jats:title>A cohort\u2010based Markov model was developed to compare costs and quality\u2010adjusted life years (QALY<\/jats:styled-content>s) between SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> and enalapril in patients with HF<\/jats:styled-content>rEF<\/jats:styled-content> over a 5\u2010year time horizon. Markov states included New York Heart Association (NYHA<\/jats:styled-content>) class (II<\/jats:styled-content>\u2010IV<\/jats:styled-content>) and death. Treatment discontinuation, HF<\/jats:styled-content>\u2010related hospitalizations, and NYHA<\/jats:styled-content> class progression were modeled as transition states based on data from the PARADIGM<\/jats:styled-content> trial. Other probabilities, costs, and utilities were obtained from published literature and public databases.<\/jats:p><\/jats:sec>Results<\/jats:title>In the base case analysis, SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> cost more than enalapril ($81,943 vs $67,287) and was more effective (2.647 QALY<\/jats:styled-content>s vs 2.546 QALY<\/jats:styled-content>s), resulting in an incremental cost\u2010effectiveness ratio of $143,891\/QALY<\/jats:styled-content> gained. At a willingness to pay (WTP<\/jats:styled-content>) of $100,000\/QALY<\/jats:styled-content>, SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> was cost\u2010effective up to a cost of $298\/month. Results were most sensitive to SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> cost, SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> mortality benefit, and NYHA<\/jats:styled-content> progression probability. SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> had a 10% and 52% probability of being cost\u2010effective at WTP<\/jats:styled-content> thresholds of $100,000\/QALY<\/jats:styled-content> and $150,000\/QALY<\/jats:styled-content>, respectively.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> is associated with clinical benefit and may be cost\u2010effective compared with the current standard of care over realistic treatment durations from the payer perspective. Results of this analysis can inform discussions on the value and position of SAC<\/jats:styled-content>\/VAL<\/jats:styled-content> in the current market.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2108","type":"journal-article","created":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T10:01:37Z","timestamp":1522404097000},"page":"520-530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cost\u2010Effectiveness Analysis of Sacubitril\/Valsartan for the Treatment of Heart Failure with Reduced Ejection Fraction in the United States"],"prefix":"10.1002","volume":"38","author":[{"given":"Patrick M.","family":"Zueger","sequence":"first","affiliation":[{"name":"Department of Pharmacy Systems, Outcomes and Policy College of Pharmacy University of Illinois at Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun M.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Economic Review Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Systems, Outcomes and Policy College of Pharmacy University of Illinois at Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianna C.","family":"Rigoni","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Systems, Outcomes and Policy College of Pharmacy University of Illinois at Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Atwood","sequence":"additional","affiliation":[{"name":"Economics Department University of Illinois at Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"DiDomenico","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice College of Pharmacy University of Illinois at Chicago Chicago Illinois"},{"name":"Center for Pharmacoepidemiology and Pharmacoeconomic Research College of Pharmacy University of Illinois at Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-8934","authenticated-orcid":false,"given":"Daniel R.","family":"Touchette","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Systems, Outcomes and Policy College of Pharmacy University of Illinois at Chicago Chicago Illinois"},{"name":"Center for Pharmacoepidemiology and Pharmacoeconomic Research College of Pharmacy University of Illinois at Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,4,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31828124ad"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.113.300268"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31820a55f5"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108013250501"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198706043162301"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010713"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000146819.43235.A9"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)04440-2"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198606123142404"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042934"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_2_6_14_1","unstructured":"CardioMEMS\u2122 HF System (St. Jude Medical Inc.) and sacubitril\/valsartan (Entresto\u2122 Novartis AG) for management of congestive heart failure: effectiveness value and value\u2010based price benchmarks. 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