Real-World Analysis of Cost Savings Related to Sacubitril-Valsartan for Heart Failure

Sacubitril-valsartan is approved by the FDA to treat heart failure with reduced ejection fraction (HFrEF). Researchers sought to determine the real-world impact on total cost of care and medical events associated with sacubitril-valsartan. Among patients who were adherent to sacubitril-valsartan for a year, the drug was associated with $6.7 million lower total costs compared with the period prior to sacubitril-valsartan initiation.

The results of the study were presented during AMCP Nexus 2020 Virtual in a poster presentation titled “Sacubitril-Valsartan Real World Assessment of Total Cost of Care and Resource Utilization Pre/Post Initiation Among Commercially Insured Members with Reduced Ejection Fraction Heart Failure.”

Researchers assessedintegrated medical and pharmacy claims data from 15 million commercially insured members aged 18 to 65 years. The study included patients with HFrEF newly initiating sacubitril-valsartan between Oct. 2018 and Sept. 2019, who were continuously enrolled for 12 months pre- and post-sacubitril-valsartan initiation. Patients were adherent to sacubitril-valsartan (defined as a proportion of days covered ≥80%) during the one-year post-sacubitril-valsartan. Pre- and post-initiation data were compared.

There was a two-month washout period during pre- and post-sacubitril-valsartan initiation date where medical costs and events were excluded because sacubitril-valsartan is generally initiated as a result of heart failure hospitalization, according to the researchers.

Total cost of care included all pharmacy and medical claims, including member-share and plan-allowed amounts, with all sacubitril-valsartan discounts applied; post-initiation costs were adjusted for inflation.

A total of 658 patients were included. Mean sacubitril-valsartan total cost of care decreased from $46,242 (standard deviation [SD], $89,058) to $36,065 (SD, $64,251) post-initiation (P<0.01), while median sacubitril-valsartan total cost of care decreased from $18,973 to $16,593 (P<0.01), representing a mean decrease of 22% in costs (95% confidence interval, 2,675-17,042).

Pharmacy costs increased by 121.5% post-initiation (P<0.01), primarily due to drug costs, but medical costs decreased by 39.5% (P<0.01). Hospitalization costs decreased from a pre-index mean of $23,892 to post-index mean of $7,360, representing a 69.2% reduction (P<0.01). Emergency department costs also decreased from a pre-index mean of $541 to a post-index mean of $378, representing a 30.1% decrease (P<0.01), while office visit costs increased from a pre-index mean of $11,369 to a post-index mean of $12,876, representing a 13.3% increase (P<0.01).

A secondary analysis of all members initiating sacubitril-valsartan, both those adherent and non-adherent during the year of follow-up, demonstrated cost neutrality.

These significant real-world findings along with a pharmaceutical manufacturer value-based contract, clinical trial data, and clinical guidelines resulted in the removal of sacubitril-valsartan prior authorization,” the researchers concluded. “Integrated medical and pharmacy benefits provide ability to execute value-based contracts, feasibility to assess medication value, and inform insurers management decisions.”

The study is limited by its use of commercial patients only.

The study was sponsored by Prime Therapeutics.

Burke JP, Sahli B, Gleason PP. Sacubitril-Valsartan Real World Assessment of Total Cost of Care and Resource Utilization Pre/Post Initiation Among Commercially Insured Members with Reduced Ejection Fraction Heart Failure. Poster I9. AMCP Nexus 2020 Virtual.