Table 1. Model Inputs.
| Input | Value (range) | Hazard ratio (95% CI) | Source |
|---|---|---|---|
| Probability of HF hospitalization, enalapril monthly | |||
| First 2 mo after hospitalization | 0.072 | NA | PIONEER-HF4 |
| >2 mo After hospitalization | 0.022 | NA | PARADIGM-HF2 |
| Sacubitril-valsartan vs enalapril | |||
| First 2 mo after discharge | NA | 0.56 (0.37-0.84) | PIONEER-HF |
| >2 mo After discharge | NA | 0.79 (0.71-0.89) | PARADIGM-HF |
| Probability of mortality, enalapril monthly | |||
| First 2 mo after discharge | 0.017 | NA | PIONEER-HF |
| >2 mo after discharge | 0.008 (0.007-0.009) | NA | PARADIGM-HF |
| Sacubitril-valsartan vs enalapril | |||
| First 2 mo after discharge | NA | 0.66 (0.30-1.48) | PIONEER-HF |
| >2 mo After discharge | NA | 0.84 (0.76-0.93) | PARADIGM-HF |
| Costs, $ | |||
| HF hospitalization | 16 467 (14 250-29 061) | NA | Medicare fee schedule or private payers9,10,12 |
| Non-HF admission | 13 319 | NA | Medicare fee schedule |
| Enalapril, annual | 175 (48-1080) | NA | Red Book WAC Price8 |
| Sacubitril-valsartan, annual | 5628 (5600-6600) | NA | Red Book WAC Price |
| Long-term outpatient costs, annual | 4790 (4204-22 032) | NA | Dunlay11 |
| In-hospital initiation program, per patient | 200 (0-100) | NA | NA |
| Utilitiesa | |||
| Sacubitril-valsartan | 0.838 (0.0833-0.0843) | NA | PARADIGM-HF |
| Enalapril | 0.829 | NA | PARADIGM-HF |
| Discount rate | 3% | NA | Second panel on CEA13 |
Abbreviations: CEA, cost-effectiveness analysis; EQ-5D, Euro-QoL 5D scale; HF, heart failure; PARADIGM-HF, Prospective Comparison of ARNI (angiotensin receptor–neprilysin inhibitor) with ACEI (angiotensin-converting enzyme inhibitor) to Determine Impact on Global Mortality and Morbidity in Heart Failure; PIONEER-HF, Comparison of Sacubitril/Valsartan Vs Enalapril on Effect on NT-proBNP (N-terminal pro b-type natriuretic peptide) in Patients Stabilized From an Acute Heart Failure Episode; WAC, wholesale acquisition cost.
Utilities were calculated based on mixed effects model based on EQ-5D scores reported at baseline and over time during the trial. Model utilities were a function of baseline EQ-5D scores, age, time, hospitalization, and treatment status. Values reported in the table are utilities for an average-age patient in the first year of the model. Further details are available in Gaziano et al.3