Table 2.
Model input values for PSoCT utilizations, costs, and utilities
| Parameter | Value | Source |
|---|---|---|
| Proportion of patients treated with individual PSoCT component [n/N (%)]a | ||
| ACEi or ARB | 3700/5040 (73.4) | VICTORIA [9] |
| β-blockers | 4691/5040 (93.1) | VICTORIA [9] |
| Sacubitril/valsartan | 731/5040 (14.5) | VICTORIA [9] |
| MRA | 3545/5040 (70.3) | VICTORIA [9] |
| Costs | ||
| Drug costs per dayb | ||
| Vericiguat | 14.57 | RED BOOK [35], prescribing information [34]c |
| ACEi or ARB | 0.03 | RED BOOK [35], prescribing information [30] |
| β-blockers | 0.05 | RED BOOK [35], prescribing information [31] |
| Sacubitril/valsartan | 14.57 | RED BOOK [35], prescribing information [32]d |
| MRA | 0.11 | RED BOOK [35], prescribing information [33] |
| Medical costs | ||
| HFH cost per event | 10,419 | Mentz et al. [29, 36]e |
| Routine care cost prior to HFH, per month | 287 | Mentz et al. [29, 36]f |
| Routine care cost during or post HFH, per month | 624 | Mentz et al. [36]; Butler et al. [11, 29]g |
| Terminal care cost, per mortality event | 9,148 | Obi et al. [29, 37]h |
| Utilities | ||
| Alive prior to HFH | 0.800 | VICTORIAi |
| Alive during HFH | 0.723 | Sandhu et al. [22]j |
| Alive post HFH | 0.800 | Assumed to be the same as (alive prior to HFH) |
ACEi angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, HFH heart failure hospitalization, MRA mineralocorticoid receptor antagonist, PSoCT prior standard-of-care therapies, WHFE worsening heart failure events
aThe utilization rates in the total VICTORIA intent-to-treat population were applied to both treatment arms
bDetailed drug wholesale acquisition costs and drug dosage used to estimate daily drug costs are shown in Table 2 in the electronic supplementary material
cThe daily cost of vericiguat applied in the cost-effectiveness analysis (i.e., $14.57) was estimated as the daily wholesale acquisition cost ($19.43), with an extra 25% discount (the discount for vericiguat was assumed to be the same as that for sacubitril/valsartan below)
dThe daily cost of sacubitril/valsartan applied in the cost-effectiveness analysis (i.e., $14.57) was estimated as the daily wholesale acquisition cost ($19.43), with an extra 25% discount (an assumption to provide an approximation of the net price based on unpublished historical pricing data of sacubitril/valsartan)
eThe HFH cost of $10,419 was estimated by inflating the HFH cost per admission of $9733 (2018 US dollars) among Medicare fee-for-service enrollees with WHFE from Mentz et al. [36], identified from a targeted literature review. Scenario analyses (see Table 4) were conducted using costs specific for Medicare Advantage and commercial health plan enrollees. Our input values in the base-case and scenario analyses were shown to be plausible as per Urbich et al. [42], a systematic literature review for medical costs associated with HF in the US, in which a range of $7319–$30,475 (2019 US dollars; payer type unspecified) was reported for HFH cost
fThe monthly routine care cost of $287 prior to HFH was estimated by inflating the monthly HF-related outpatient cost of $268 (2018 US dollars) in Medicare fee-service enrollees with WHFE from Mentz et al. [36]. There was a lack of reporting of monthly HF-related routine care cost in Urbich et al. [42] for potential external validation. Scenario analyses (see Table 4) were conducted using costs specific for Medicare Advantage and commercial health plan enrollees obtained from more recent literature after publication of the systematic review by Urbich et al. [42]
gThe monthly cost of routine care in or post HFH was estimated by applying a ratio of 2.17 to the monthly cost of $287 prior to HFH. The ratio of 2.17 was derived from Butler et al. [11], which compared the monthly HF-related routine care cost between patients with stable HFrEF ($132) and patients with a recent WHFE ($132) in the commercially insured population
hThe terminal care cost of $9148 per mortality event was estimated by inflating the average HF-related medical cost of $7495 (2013 US dollars) among Medicare Advantage enrollees in their last month before death from the study by Obi et al [37]. This reference was identified from a targeted literature review. There was a lack of reporting of terminal care cost from Urbich et al. [42] for potential external validation. A scenario analysis (see Table 4) was conducted using commercial payer-specific costs
iThe utility for patients alive and not alive in HFH (0.8) was derived from baseline EQ-5D-5L data in the VICTORIA intent-to-treat population using the US value set. The model assumes no treatment-specific benefit related to EQ-5D. When patients move to the ‘alive post the first HFH’ health state after HFH, we assumed the utility would increase back to 0.8
jPatients who were hospitalized due to HF were expected to have poorer health-related quality of life than patients not in HFH; therefore, a utility decrement was applied on top of the utility without HFH to estimate the utility with HFH. Due to a paucity of EQ-5D data from VICTORIA that coincided with HFH, a disutility of 0.077 was estimated based on Sandhu et al. [22] (identified from a targeted literature review of prior US cost-effectiveness models, as shown in Supplementary Table 4), in which a 9.7% decrease was assumed for patients in HFH. The disutility value (0.077) applied in our analysis was shown to be plausible as per Di Tanna et al. [41], a systematic literature review for health-related quality of life in patients with HF, in which a range of 0.001 to approximately 0.1 was reported for utility decrements due to hospitalization