Table 4.

Scenario analysis results

Parameter	Base-case setting	Scenario analysis setting	Incremental costs per patient	Incremental QALYs per patient	Cost per QALY gained per patient
Base case			$23,322	0.28	$82,448
Discounting rate per year for costs and clinical outcomes	Costs: 3% Clinical: 3%	Costs: 0% Clinical: 0%	$25,911	0.34	$76,049
		Costs: 6% Clinical: 6%	$21,205	0.24	$89,004
Parametric distribution for risk of CV death post HFH	Gompertz	Weibull	$28,546	0.36	$78,946
		Gamma	$28,745	0.30	$95,164
Daily drug acquisition cost of both vericiguat and sacubitril/valsartan	$19.43 with 25% discount ($14.57)a	$19.43 with 35% discount ($12.63)	$20,321	0.28	$71,839
		$19.43 with 30% discount ($13.60)	$21,821	0.28	$77,143
		$19.43 with 20% discount ($15.54)	$24,822	0.28	$87,753
HFH cost per HFH event; routine care cost per month prior to HFH; routine care cost per month post HFH; terminal care cost per mortality event	Medicare perspectiveb: $10,419; $287; $624; $9148	Medicare perspective (alternative estimates)c: $13,673; $159; $346; $9148	$22,773	0.28	$80,507
		Commercial payer perspectived: $23,605; $307; $668; $31,779	$22,908	0.28	$80,983
		$0 for the terminal care cost	$23,417	0.28	$82,785

CV cardiovascular, HFH heart failure hospitalization, LYs life-years, PSoCT prior standard-of-care therapies, QALYs quality-adjusted life-years, WHFE worsening heart failure events

^aThe daily cost of both sacubitril/valsartan and vericiguat applied in the cost-effectiveness analysis (i.e., $14.57) was estimated as the daily wholesale acquisition cost for sacubitril/valsartan (i.e., $19.43), with an extra 25% discount (assumption)

^bIn the base case, the HFH and routine care costs were based on Medicare fee-for-service costs, whereas the terminal care cost was based on Medicare Advantage costs (see Table 2 for more details of base-case input estimates and references)

^cThe references and estimation of the alternative Medicare costs applied in the scenario analysis were exactly the same as those adopted for the base-case analysis. The exception is that in the base-case analysis, the HFH and routine care costs were based on Medicare fee-for-service costs, whereas in the scenario analysis, the HFH and routine care costs were based on Medicare Advantage costs

^dThe HFH cost of $23,605 was estimated by inflating the HFH cost per admission of $22,050 (2018 US dollars) among Medicare Advantage enrollees with WHFE from Butler et al. [11]. The monthly routine care cost of $307 prior to HFH was estimated by inflating the monthly HF-related outpatient cost of $287 (2018 US dollars) in Medicare Advantage enrollees with WHFE from Butler et al. [11]. Same as the base-case analysis, the monthly cost of routine care in or post HFH was estimated by applying a ratio of 2.17 (per Butler et al. [11]) to the monthly cost prior to HFH. The terminal care cost of $31,779 per mortality event was estimated by inflating the average HF-related medical cost of $26,037 (2013 US dollars) among commercially insured enrollees in their last month before death from Obi et al. [37]