<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0420</journal-id>
<journal-title><![CDATA[Revista Uruguaya de Cardiología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev.Urug.Cardiol.]]></abbrev-journal-title>
<issn>1688-0420</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Cardiología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-04202026000101202</article-id>
<article-id pub-id-type="doi">10.29277/cardio.41.1.2</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Análisis de costo-utilidad de sacubitril/valsartán para el tratamiento de insuficiencia cardíaca con fracción de eyección reducida en Uruguay]]></article-title>
<article-title xml:lang="en"><![CDATA[Cost-utility analysis of sacubitril/valsartan for the treatment of heart failure with reduced ejection fraction in Uruguay]]></article-title>
<article-title xml:lang="pt"><![CDATA[Análise de custo-utilidade dosacubitril/valsartan para o tratamento da insuficiencia cardíaca com fração de ejeção reduzida no Uruguai]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ramírez]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliver]]></surname>
<given-names><![CDATA[María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Torales]]></surname>
<given-names><![CDATA[Santiago]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Szargala]]></surname>
<given-names><![CDATA[Sebastián]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vieira da Cunha]]></surname>
<given-names><![CDATA[Analía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,santiago.torales@gmail.com  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<volume>41</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-04202026000101202&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-04202026000101202&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-04202026000101202&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  la insuficiencia cardíaca (IC) presenta prevalencia creciente y nuevas alternativas terapéuticas se enfocan en reducir su alto impacto económico y organizacional en los sistemas de salud.  Objetivos:  estimar los costos de la IC con fracción de eyección reducida (ICFEr) en Uruguay y desarrollar un análisis de costo-utilidad sobre el uso de sacubitril/valsartán en pacientes adultos con esta patología vs. terapia convencional con inhibidores de convertasa/antagonistas de los receptores de angiotensina II (IECAs/ARA2) desde la perspectiva del Sistema Nacional Integrado de Salud (SNIS) de Uruguay.  Métodos:  se elaboró una vía clínica con microcosteo, incorporada a un modelo de Márkov con 3 estados de salud y probabilidades de transición del estudio PARADIGM-HF. El proceso se validó con especialistas locales para adaptación al contexto uruguayo. Se determinó la razón de costo-utilidad incremental (RCUI) en dólares por años de vida ajustado por calidad (USD/AVAC) para un umbral de 1 PBI per cápita (USD 22.422), con dos horizontes temporales (27 y 60 meses). Se aplicaron análisis de sensibilidad determinísticos sobre variables relevantes.  Resultados:  la atención de la ICFEr representaría un gasto anual de USD 142,4 millones, un costo promedio de atención anual de USD 3.968 por paciente y un costo de hospitalización de USD 9.231 por evento. Incorporar la cobertura total de sacubitril/valsartán incrementaría a USD 5.178 el costo anual por paciente. La RCUI para 27 meses fue de USD 91.970/AVAC y para 60 meses de USD 50.032/AVAC. Las variables que más influyeron en los resultados fueron el costo del fármaco y la probabilidad de internación por IC.  Conclusiones:  incorporar sacubitril/valsartán incrementaría de manera relevante el costo de la ICFEr y representaría una intervención no costo efectiva en Uruguay, el modelo es sensible a la variación del costo del fármaco.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary:  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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  a insuficiência cardíaca (IC) tem uma prevalência crescente e novas alternativas terapêuticas centram-se na redução do seu elevado impacto económico e organizacional nos sistemas de saúde. Metas: estimar os custos da IC com fração de ejeção reduzida (ICFEr) no Uruguai e desenvolver uma análise custo-utilidade do uso de sacubitril/valsartana em pacientes adultos com esta patologia vs. terapia convencional com inibidores da convertase/bloqueadores do recetor da angiotensina II (IECA/BRA) na perspectiva do Sistema Integrado Nacional de Saúde (SNIS) do Uruguai.  Métodos:  foi desenvolvida uma trajetória clínica com microcustos, incorporada a um modelo de Márkov com 3 estados de saúde e probabilidades de transição do estudo PARADIGM-HF. O processo foi validado com especialistas locais para se adaptar ao contexto uruguaio. O rácio custo-utilidade incremental (ICUR) foi determinado em dólares por anos de vida ajustados pela qualidade (USD/QALY) para um limiar de 1 PIB per capita (USD 22.422), com dois horizontes temporais (27 e 60 meses). Análises de sensibilidade determinísticas foram aplicadas em variáveis relevantes.  Resultados:  os cuidados com ICFEr representariam um gasto anual de USD 142,4 milhões, um custo médio anual de cuidados de USD 3.968/paciente e um custo de hospitalização de USD 9.231/evento. A incorporação da cobertura total do sacubitril/valsartan aumentaria o custo anual por paciente para 5.178 dólares. O IUR para 27 meses foi de USD 91.970/QALY e para 60 meses foi de USD 50.032/QALY. As variáveis que mais influenciaram os resultados foram o custo do medicamento e a probabilidade de hospitalização por IC.  Conclusões:  a incorporação de sacubitril/valsartan aumentaria significativamente o custo da ICFEr e representaria uma intervenção não custo-efetiva no Uruguai, o modelo é sensível às variações no preço do medicamento.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[INSUFICIENCIA CARDÍACA]]></kwd>
<kwd lng="es"><![CDATA[SACUBITRIL VALSARTÁN]]></kwd>
<kwd lng="es"><![CDATA[FRACCIÓN DE EYECCIÓN REDUCIDA]]></kwd>
<kwd lng="es"><![CDATA[COSTO-UTILIDAD]]></kwd>
<kwd lng="es"><![CDATA[ANÁLISIS ECONÓMICO]]></kwd>
<kwd lng="en"><![CDATA[HEART FAILURE]]></kwd>
<kwd lng="en"><![CDATA[SACUBITRIL VALSARTAN REDUCED EJECTION FRACTION]]></kwd>
<kwd lng="en"><![CDATA[COST-UTILITY]]></kwd>
<kwd lng="en"><![CDATA[ECONOMIC ANALYSIS]]></kwd>
<kwd lng="pt"><![CDATA[INSUFICIÊNCIA CARDÍACA]]></kwd>
<kwd lng="pt"><![CDATA[SACUBITRIL VALSARTAN]]></kwd>
<kwd lng="pt"><![CDATA[FRAÇÃO DE EJEÇÃO REDUZIDA]]></kwd>
<kwd lng="pt"><![CDATA[COSTO-UTILIDADE]]></kwd>
<kwd lng="pt"><![CDATA[ANÁLISE ECONÓMICA]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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