Introduction:

heart failure (HF) is increasingly prevalent and new therapeutic alternatives are focused on reducing its high economic and organizational impact on health systems.

Objectives:

to estimate the costs of HF with reduced ejection fraction (HFrEF) in Uruguay and to develop a cost-utility analysis on the use of sacubitril/valsartan in adult patients with this pathology vs. conventional therapy with convertase inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) from the perspective of the National Integrated Health System (SNIS) of Uruguay.

Methods:

a clinical pathway with microcosting was developed, incorporated into a Markov model with 3 health states and transition probabilities from the PARADIGM-HF study. The process was validated with local specialists for adaptation to the Uruguayan context. The incremental cost-utility ratio (ICUR) was determined in dollars per quality-adjusted life year (USD/QALY) for a threshold of 1 GDP per capita (USD 22,422), with two time horizons (27 and 60 months). Deterministic sensitivity analyses were applied to relevant variables.

Results:

HFrEF care would represent an annual expenditure of USD 142.4 million, an average annual care cost of USD 3,968/patient and a hospitalization cost of USD 9,231/event. Incorporating full coverage of sacubitril/valsartan would increase the annual cost/patient to USD 5,178. The RCUI for 27 months was USD 91,970/QALY and for 60 months USD 50,032/QALY. The variables that most influenced the results were the cost of the drug and the probability of hospitalization for HF.

Conclusions:

incorporating sacubitril/valsartan would significantly increase the cost of HFrEF and would represent a non-cost-effective intervention in Uruguay, being the model sensitive to variations in the price of the drug.

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