5 Citations (Scopus)
85 Downloads (Pure)

Abstract

Background: To assess the cost-effectiveness of new treatments in Germany, the efficiency frontier (EF) method has been developed. We compared the cost-effectiveness analysis using international standards and the German methodology, using the heart failure drug sacubitril/valsartan as an example.

Methods: A previously developed Markov model was adapted to include 4 treatment options: no treatment, enalapril, candesartan, and sacubitril/valsartan. The internationally used incremental cost-effectiveness ratio (ICER) was calculated, as well as cost-effectiveness acceptability curves. Additionally, EFs, net monetary benefits (NMBs), and price-acceptability curves were created according to German guidelines. All analyses were performed from the perspective of the German Statutory Health Insurance.

Results: The base-case ICER for sacubitril/valsartan compared to enalapril is (sic)19 300/quality-adjusted life-year. On the cost-effectiveness acceptability curve, sacubitril/valsartan is most likely to be cost-effective, out of all included comparators, from a hypothetical willingness-to-pay threshold of (sic)18 250/quality-adjusted life-year onward. No EF could be constructed for the base case. Taking the uncertainty of the input parameters into account for the probabilistic sensitivity analysis, a NMB of around -(sic)14 000 was calculated, depending on the outcome considered, with the NMB being zero at a daily price for sacubitril/valsartan ranging from (sic)1.52 to (sic)1.67.

Conclusion: We calculated an ICER for Germany, comparable to previously published cost-effectiveness analyses for Europe, which widely concluded sacubitril/valsartan to be cost-effective. Using the German EF approach, a considerable discount needs to be applied before sacubitril/valsartan can be considered cost-effective.

Original languageEnglish
Pages (from-to)1119-1127
Number of pages9
JournalValue in Health
Volume22
Issue number10
DOIs
Publication statusPublished - Oct-2019

Keywords

  • efficiency frontier approach
  • CHRONIC HEART-FAILURE
  • RECEPTOR NEPRILYSIN INHIBITION
  • REDUCED EJECTION FRACTION
  • WILLINGNESS-TO-PAY
  • ADJUSTED LIFE-YEAR
  • ECONOMIC-EVALUATION
  • DECISION-MAKING
  • CARE
  • ENALAPRIL
  • MORTALITY

Cite this