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GUIDELINES/RECOMMENDATIONS How can the balance between health outcomes and drug affordability be optimized in the era of high-priced brand-only heart failure medications?
A recent study on the cost-effectiveness of quadruple therapy for heart failure treatment highlights its potential benefit in terms of quality-adjusted life years (QALYs), yet raises questions about drug affordability and equity of access for patients.
Key Points:
- A study assessed the cost-effectiveness of guideline-recommended quadruple therapy for heart failure with reduced ejection fraction, involving an angiotensin receptor-neprilysin inhibitor (ARNi), sodium-glucose cotransporter-2 (SGLT-2) inhibitor, mineralocorticoid receptor antagonist (MRA), and beta-blocker.
- Addition of SGLT-2 inhibitor to the previous standard of care showed an intermediate cost-effectiveness with an incremental cost-effectiveness ratio of $73,000/QALY.
- Achieving quadruple therapy with addition of an ARNi resulted in 0.68 additional QALY at a cost of $66,700, leading to an incremental cost-effectiveness ratio of $98,500/QALY.
Additional Points:
- The incremental cost-effectiveness of quadruple therapy versus the previous standard varied from $73,500/QALY (based on Department of Veterans Affairs prices) to $110,000/QALY (using drug list prices).
- The list wholesale price per unit for drugs dapagliflozin and empagliflozin rose by 76% and 90% respectively from 2014 to 2022, while a 30-day supply of ARNi saw a 70% price increase from 2015 to 2022.
Conclusion:
- Although quadruple therapy has proven benefits for patients with heart failure with reduced ejection fraction, the high and rising costs of these brand-only drugs could limit their cost-effectiveness and accessibility.
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“ARNis and [SGLT-2 inhibitors] have trial-proven benefits for patients with [heart failure with reduced ejection fraction], but the substantial costs of these brand-only drugs with rising list prices may deserve additional scrutiny by payers and policymakers alike to ensure not only cost-effectiveness but also equitable access and affordability for patients.”
Authors of the study