The objective of this study was to evaluate the pharmacoeconomic value of sacubitril-valsartan for the treatment of heart failure (HF). PubMed, Embase, Cochrane Library, ScienceDirect, Scopus, CNKI, Wanfang, and VIP databases were searched systematically and the retrieval time ended in August 2019. According to the criteria of inclusion and exclusion, the quality of studies included was evaluated as per the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) scale, and the results were extracted and analyzed systematically. The total of 11 cost-effectiveness studies was identified, 10 were performed in the developed countries and 1 in Thailand. All the patients in the studies had chronic heart failure with reduced ejection fraction (HFrEF). Totally, the quality of all the 11 studies was reported to be of an average score of 20.5. Study perspective and time horizons were described in the 11 studies. All included studies discounted the cost or effectiveness. Only 1 study estimated direct and indirect costs; 10 studies evaluated direct cost. The incremental cost-effectiveness ratio (ICER) of sacubitril-valsartan treating HFrEF was $13,150 per quality-adjusted life-years (QALY) in Thailand and $86,735 in Singapore. In European countries, the ICER was from $21,786 to $34,576 per QALY and mean value was $25,410.6 per QALY. In the USA, ICER values ranged from $47,099 to $143,891 per QALY, and mean value was $73,383.5 per QALY; ICER was $30,090 per QALY in Colombia. With the exception of Thailand and Singapore, the ICER of other countries in the included literature was below the implemented country-specific thresholds. Based on existing literatures, with the exception of Thailand and Singapore, sacubitril-valsartan for the treatment of HFrEF is a better cost-effective therapy with ICER basically below the implemented country-specific thresholds. Sacubitril-valsartan was not considered a cost-effective treatment for heart failure with reduced ejection fraction in Thailand and Singapore with the current economic evaluation evidences, but with the willingness-to-pay (WTP) of other counties, sacubitril-valsartan was found to be a cost-effective treatment compared with comparator. Drug cost, time horizon, and hospitalization were the most influential variables across studies. Four studies indicated that with the longer time horizon, the lower ICER value would gain. Further studies are warranted to better evaluate comprehensive utility value of sacubitril-valsartan on heart failure.

中文翻译：

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沙库巴曲缬沙坦治疗心力衰竭的成本效益分析。

本研究的目的是评估沙库巴曲缬沙坦治疗心力衰竭 (HF) 的药物经济学价值。系统检索了PubMed、Embase、Cochrane Library、ScienceDirect、Scopus、CNKI、万方、VIP等数据库，检索时间截止至2019年8月。按照纳入排除标准，纳入研究的质量按照综合评价标准进行评价。卫生经济评价报告标准（CHEERS）量表，并对结果进行系统提取和分析。共确定了 11 项成本效益研究，其中 10 项在发达国家进行，1 项在泰国进行。研究中的所有患者都患有射血分数降低的慢性心力衰竭 (HFrEF)。总的来说，所有 11 项研究的质量报告平均得分为 20.5。11 项研究描述了研究视角和时间范围。所有纳入的研究都对成本或有效性打了折扣。只有 1 项研究估计了直接和间接成本；10 项研究评估了直接成本。沙库巴曲缬沙坦治疗 HFrEF 的增量成本效益比 (ICER) 在泰国为每质量调整生命年 (QALY) 13,150 美元，在新加坡为 86,735 美元。在欧洲国家，ICER 为每 QALY 21,786 美元至 34,576 美元，平均值为每 QALY 25,410.6 美元。在美国，ICER 值从每个 QALY 47,099 美元到 143,891 美元不等，平均值为每个 QALY 73,383.5 美元；在哥伦比亚，ICER 为每个 QALY 30,090 美元。除泰国和新加坡外，纳入文献中其他国家的 ICER 均低于实施的国家特定阈值。根据现有文献，除泰国和新加坡外，沙库巴曲缬沙坦治疗 HFrEF 是一种更具成本效益的疗法，ICER 基本低于实施的国家特定阈值。根据当前的经济评估证据，在泰国和新加坡，沙库巴曲缬沙坦不被认为是射血分数降低的心力衰竭的经济有效的治疗方法，但根据其他国家的支付意愿（WTP），发现沙库巴曲缬沙坦与比较器相比，是一种具有成本效益的治疗方法。药物成本、时间范围和住院是所有研究中最具影响力的变量。四项研究表明，随着时间跨度越长，ICER 值将越低。需要进一步研究以更好地评估沙库巴曲缬沙坦对心力衰竭的综合效用价值。沙库巴曲缬沙坦治疗 HFrEF 是一种更具成本效益的疗法，ICER 基本低于实施的国家特定阈值。根据当前的经济评估证据，在泰国和新加坡，沙库巴曲缬沙坦不被认为是射血分数降低的心力衰竭的经济有效的治疗方法，但根据其他国家的支付意愿（WTP），发现沙库巴曲缬沙坦与比较器相比，是一种具有成本效益的治疗方法。药物成本、时间范围和住院是所有研究中最具影响力的变量。四项研究表明，随着时间跨度越长，ICER 值将越低。需要进一步研究以更好地评估沙库巴曲缬沙坦对心力衰竭的综合效用价值。沙库巴曲缬沙坦治疗 HFrEF 是一种更具成本效益的疗法，ICER 基本低于实施的国家特定阈值。根据当前的经济评估证据，沙库巴曲缬沙坦在泰国和新加坡不被认为是射血分数降低的心力衰竭的成本有效治疗方法，但在其他国家的支付意愿（WTP）中，沙库巴曲缬沙坦被发现与比较器相比，是一种具有成本效益的治疗方法。药物成本、时间范围和住院是所有研究中最具影响力的变量。四项研究表明，随着时间跨度越长，ICER 值将越低。需要进一步研究以更好地评估沙库巴曲缬沙坦对心力衰竭的综合效用价值。