AUTHOR=Lou Yake , Yu Ying , Liu Jinxing , Huang Jing 

TITLE=Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.959139

DOI=10.3389/fpubh.2022.959139

ISSN=2296-2565

ABSTRACT=Background: Sacubitril-valsartan was recommended in heart failure (HF) and proven 
cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat 
hypertension in Chinese expert consensus. The cost-utility of sacubitril-valsartan for
hypertension remains uninvestigated.
Methods: A meta-analysis of randomized controlled trials was performed to investigate the 
real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor 
blockers or placebo. A lifetime Markov model was developed to compare the cost-utility of 
sacubitril-valsartan versus valsartan. The primary outcome was incremental costs utility 
ratio (ICUR), representing the ratio of incremental costs to incremental utility. The 
willingness-to-pay (WTP) threshold was 3 times of per capita GDP in China in 2021.
Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the 
WTP threshold, and not cost-effective if higher than the threshold. 
Results: A total of 10 RCTs of 5,781 patients were included in the meta-analysis. For 
comparison of sacubitril-valsartan 400 mg/day versus valsartan 320 mg/day, a reduction in 
BP of -5.97 [-6.38, -5.56] (p＜0.01) was observed. Cost-utility analysis showed that for a 60 
years old hypertension patient, if sacubitril-valsartan was prescribed as the antihypertensive 
agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALY) with costs of 
65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life 
expectancy would be 11.82 QALY with costs of 54,769 CNY, thus an ICUR of 108,622 
CNY/QALY was obtained, lower than the WTP threshold. 
Conclusion: Compared with valsartan, sacubitril-valsartan is more effective in reducing 
blood pressure and may results in more quality adjusted life year, although with higher costs. 
Sacubitril-valsartan is cost-effective for hypertension in current China setting under the 
willingness-to-pay threshold of 3 times of per capita GDP.