Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials.

Abstract

Background:

Sacubitril-valsartan was recommended for heart failure (HF) and proven cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat hypertension by the Chinese expert consensus. The cost utility of sacubitril-valsartan for hypertension remains uninvestigated.

Methods:

A meta-analysis of randomized controlled trials (RCTs) was performed to investigate the real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor blockers or placebo. A lifetime Markov model was developed to compare the cost utility of sacubitril-valsartan vs. valsartan. The primary outcome was the incremental cost-utility ratio (ICUR), representing the ratio of incremental costs to the incremental utility. The willingness-to-pay (WTP) threshold was three times of per capita gross domestic product (GDP) in China in 2021. Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the WTP threshold, otherwise, sacubitril-valsartanis was not cost-effective.

Results:

A total of 10 RCTs of 5,781 patients were included in the meta-analysis. For comparison of sacubitril-valsartan 400 mg/day vs. valsartan 320 mg/day, a reduction in blood pressure (BP) of -5.97 (-6.38, -5.56) (p < 0.01) was observed. Cost-utility analysis showed that for a 60-year-old patient with hypertension, if sacubitril-valsartan was prescribed as the antihypertensive agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALYs) with costs of 65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life expectancy would be 11.82 QALY with costs of 54,769 CNY; thus, an ICUR of 108,622 CNY/QALY was obtained, lower than the WTP threshold.

Conclusion:

Compared with valsartan, sacubitril-valsartan is more effective in reducing blood pressure and may result in more quality-adjusted life-year, although with higher costs. Sacubitril-valsartan is cost-effective for hypertension in the current China setting under the willingness-to-pay threshold of 3 times of per capita GDP.

• Authors: Yake Lou, Ying Yu, Jinxing Liu, Jing Huang
• Journal: Frontiers in public health (Front Public Health) Vol. 10 Pg. 959139 ( 2022) ISSN: 2296-2565 [Electronic] Switzerland
• PMID: 36062091 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2022 Lou, Yu, Liu and Huang.

Chemical References

• Aminobutyrates
• Antihypertensive Agents
• Biphenyl Compounds
• sacubitril
• Valsartan

Topics

• Aminobutyrates
• Antihypertensive Agents (pharmacology, therapeutic use)
• Biphenyl Compounds
• Cost-Benefit Analysis
• Heart Failure (drug therapy)
• Humans
• Hypertension (drug therapy)
• Male
• Middle Aged
• Randomized Controlled Trials as Topic
• Valsartan (pharmacology, therapeutic use)