Heart Failure Guidelines Found Borderline Cost-Effective

Recent Harvard Chan School MPH graduate Brandon Yan and CHDS faculty Ankur Pandya published a cost-effectiveness analysis of the new 2022 guideline-directed therapy for heart failure with reduced ejection fraction (HFrEF) in Circulation Cardiovascular Quality and Outcomes. The authors found that the addition of two newer medical therapies to standard of care, an angiotensin receptor/neprilysin inhibitor (ARNi) and a sodium-glucose cotransporter-2 inhibitor (SGLT2i), was borderline cost-effective at the conventional cost-effectiveness threshold.

Heart failure affects 6 million Americans and accounts for up to $127 billion in annual healthcare cost. In 2022, clinical guidelines for treating heart failure with reduced ejection fraction (HFrEF), a subtype of heart failure comprising half of heart failure cases, changed to include the ARNi and SGLT2i as part of first-line therapy. Clinical trials have shown these newer drugs reduce a patient’s risk of hospitalization and death when experiencing heart failure. However, these two drugs come at a combined estimated cost of $12,000 per year and the cost-effectiveness of adding both the ARNi and SGLT2i has not been well-studied.

The authors found that adding both the ARNi and SGLT2i offered a cost-to-effectiveness ratio of $98,500 per each additional quality-adjusted life year (QALY) gained as compared to adding one alone–the SGLT2i. The addition of the sGLT2i alone to the previous standard of care was cost-effective at a ratio of $73,000 per QALY.

While the list price of these drugs has nearly doubled since they were first introduced, payers must negotiate increasingly large discounts to ensure cost-effectiveness. In addition, patients can face substantial cost-sharing burdens, which raises affordability concerns. The authors discuss the potential role for drug price regulation to ensure cost-effectiveness and affordability.

The study was conducted in collaboration with cardiologist Aferdita Spahillari at Massachusetts General Hospital and Harvard Medical School.

Learn more: Read the publication, Cost-Effectiveness of Quadruple Therapy in Management of Heart Failure With Reduced Ejection Fraction in the United States
Learn more: Read the related review article, 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines