Abstract

Introduction: Sacubitril/valsartan (SV) is a heart failure (HF) drug approved in 2015 that showed benefit compared to enalapril in patients with systolic heart failure (SHF) in clinical trials, but lacks real world evidence of benefit compared to use of other ACEI or ARB regimens, including valsartan.

Methods: The study analyzed claims of geographically diverse commercial and Medicare Advantage health plan members with HF. Using propensity scores based on demographic, healthcare utilization, and health factors, we matched new SV patients with patients initiating or changing an ACEI/ARB regimen from 07/2015 to 04/2017. We calculated incidence rates for first all-cause and HF-related hospitalization. Costs were assessed over all available time.

Results: About 98% of SV patients had SHF. Compared to ACEI/ARB, SV patients had 30% lower risk of all-cause hospitalization, with females having a greater reduction (IRR=0.59) than males (IRR=0.80). HF-related hospitalizations were reduced 20% in SV patients. SV patients had total cost savings within the first 3 months ($-748) from lower inpatient costs; however, the savings diminished over time as higher pharmacy costs (primarily due to SV costs) were not offset by lower medical costs.

Conclusions: When SV is used in a population where there is evidence of clinical benefit (i.e., patients with SHF), its use is associated with reduced all-cause and HF-related hospitalization, particularly in females; however, the cost savings of reduced hospitalizations may be offset over time by increased pharmacy costs. This study further supports programs that help ensure use of SV in a population where there is evidence of clinical benefit.