Table.
| Drug (Estimated 2018 Cost)3 | First Author (Year) | Industry Sponsor | CEA Cost | LY; QALY Gain | Cost Difference | ICER ($/QALY or $/LY)4 | Comments |
| Beta-blockers | |||||||
| Bisoprolol ($188) | Gregory (2001) [34] | N | $379 | 1.04; NA | $3,455 | $3,336/LY | Based on CIBIS-II trial; no QALY data |
| Carvedilol ($55) | Delea (1999) [37] | Y | $1,096 | 0.79; NA | $15,735 | $19,918/LY | Based on US Carvedilol Trial; no QALY data |
| Gregory (2001) [34] | N | $2,000 | 2.40; NA | $15,656 | $6,740/LY | Based on US Carvedilol Trial; no QALY data | |
| Metoprolol Succinate ($183) | Gregory (2001) [34] | N | $612 | 1.06; NA | $2,613 | $2,472/LY | Based on MERIT-HF and MDC Trial; no QALY data |
| Any ($55)5 | Banka (2013) [38] | N | $48 | 0.31; 0.24 | $411 | $1,323/QALY | Based on MERIT-CHF trial |
| Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers | |||||||
| Captopril ($812) | Tsevat (1995) [29] | Y | $631 | NA; 0.52 | $2,933 | $5,600/QALY | Based on SAVE trial; results displayed for 60yo cohort |
| Enalapril ($192) | Paul (1994) [32] | N | $959 | NA; 0.27 | $2,569 | $9,731/LY | Based on SOLVD and V-HeFT-II trials; only a 10-year time horizon; no QALY data |
| Glick (1995) [35] | Y | $2486 | 0.30; 0.21 | $25 | $115/QALY | Based on SOLVD trial | |
| Any ($40)5 | Banka (2013) [38] | N | $48 | 0.15; 0.12 | -$444 | Dominant Strategy7 | Based on SOLVD trial |
| Shekelle (2003) [30] | N | $5206 | 0.64; 0.66 | $3,718 | $5,644/QALY | Based on SOLVD trial | |
| Mineralocorticoid Receptor Antagonists | |||||||
| Eplerenone ($961) | Weintraub (2005) [28] | Y | $1,1385 | 0.06–0.13; 0.04–0.09 | $1,923-$2,323 | $23,724-$43,301 | Based on EPHESUS trial8 |
| Any ($78)5 | Banka (2013) [38] | N | $48 | 0.10; 0.07 | $47 | $501/QALY | Based on EMPHASIS-HF trial |
| Hydralazine-Nitrates | |||||||
| Hydralazine-Nitrates ($720) | Angus (2005) [39] | Y | $1,971 | 0.26; NA | $10,900 | $44,400/LY | Based on A-HeFT trial; assumed treatment efficacy for only a 2-year duration; no QALY data |
| Sacubitril-Valsartan | |||||||
| Sacubitril-Valsartan ($5,315) | Sandhu (2016) [31] | N | $4,563 | 0.69; 0.62 | $29,204 | $47,053/QALY | Based on PARADIGM-HF trial |
| King (2016) [43] | N | $4,560 | 1.08; 0.76 | $38,633 | $50,959/QALY | Based on PARADIGM-HF trial | |
| Gaziano (2016) [36] | Y | $4,500 | 1.43; 0.78 | $35,200 | $45,017/QALY | Based on PARADIGM-HF trial | |
| Gaziano (2020) [44] | Y | $5,628 | 1.51; 1.24 | $27,353 | $21,532/QALY | Based on PARADIGM-HF and PIONEER-HF; cost-saving when including societal indirect costs | |
| Ivabradine | |||||||
| Ivabradine ($4,706) | Kansal (2016) [33] | Y | $4,500 | 0.16; 0.20 | $4,913 | $24,920/QALY | Based on SHIFT trial; results displayed for Medicare Advantage population; only a 10-year time horizon |
| SGLT-2 Inhibitors | |||||||
| Dapagliflozin ($5,488) | Parizo (2021) [45] | Y | $474 | 0.78; 0.46 | $38,212 | $83,650 QALY | Based on DAPA-HF trial; |
Abbreviations: A-HeFT: African-American Heart Failure; CIBIS-II: Cardiac Insufficiency Bisoprolol Study II; DAPA-HF: Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure; EMPHASIS-HF: Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure; EPHESUS: Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study; MDC: Metoprolol in Dilated Cardiomyopathy; MERIT-HF: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure; NA: not available; PARADIGM-HF: Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure; PIONEER-HF: Comparison of Sacubitril–Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode; QALY: quality-adjusted life year; SHIFT: Systolic Heart failure treatment with the If inhibitor Ivabradine Trial; SOLVD: Studies of Left Ventricular Dysfunction; V-HeFT II: Vasodilator-Heart Failure Trial II.
Limited to economic evaluations that include an assessment of clinical benefit via either life-years or quality-adjusted life years and total healthcare costs. Excluded studies without a medium to long-term time horizon.
Estimated cost based on Medicare Part D spending for the drug. Generic costs were utilized when available. For non-specific drugs, the drug with the lowest cost was utilized. This amount does not include proprietary rebates between patented drugs and pharmaceutical plans, which average over 20% of cost across patented drugs. For individual patients, out-of-pocket costs will vary depending on their pharmaceutical plan.
When available, cost per quality-adjusted life years is preferable. For multiple studies, quality-adjusted life years was not calculated. For these studies, results were represented as $/life-year gained.
Estimated cost for the lowest-cost generic in that class.
Approximated based on trial drug costs and trial follow-up duration.
Indicates preferable strategy given lower cost and better clinical outcomes.
Modeled post-trial outcomes using three different patient cohorts leading to range of results.