Сost-effectiveness of preventing cardiovascular death and achieving the target indicator "Reduction of the cardiovascular mortality of the population" of the State Program "Health Development" when using valsartan+sacubitril, dapagliflozin and empagliflozin in patients with heart failure with reduced ejection fraction

Aim. To evaluate the cost-effectiveness of achieving the target indicator "Reduction of the cardiovascular mortality of the population" of the State Program "Health Development" when using drugs valsartan+sacubitril, dapagliflozin and empagliflozin in patients with New York Heart Association (NYHA) class II-IV heart failure with reduced ejection fraction ≤40% s in 2023-2024.

Material and methods. The target population was Russian patients who received preferential medicines in the last two years after an acute cardiovascular disease. The population size was determined on the basis of Russian literary and statistical sources. To predict the cardiovascular death, a parametric modeling method was used based on published data from clinical trials. The amount of drug costs required to prevent one cardiovascular death, as well as to achieve a one target for reducing cardiovascular mortality, was calculated using each of the comparator drugs in the whole country and separately in each region.

Results. The cost of drugs for the 1^st year of therapy to prevent one cardiovascular death in the case of valsartan+sacubitril was RUB 3,99 million, dapagliflozin — RUB 2,63 million, empagliflozin — RUB 4,43 million. There were following costs required to achieve one target indicator for reducing cardiovascular mortality of the State Program "Health Development" for valsartan+sacubitril, dapagliflozin and empagliflozin:

• in 2023 — RUB 2197,9 million, RUB 1451,5 million and RUB 2435,9 million, respectively;
• in 2024 — RUB 627,4 million, RUB 407,7 million and RUB 706,9 million, respectively.

Conclusion. Among the agents considered, dapagliflozin seems to be the most cost effective for preventing one cardiovascular death and achieving one of the target "Reduction of the cardiovascular mortality" of the State Program "Health Development" in 2023-2024.

1. Russian Society of Cardiology (RSC). 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) doi:10.15829/1560-4071-2020-4083.

2. Reznik EV, Nikitin IG. Algorithm for the treatment of patients with chronic heart failure with reduced left ventricular ejection fraction. The Russian Archives of Internal Medicine. 2018;8(2):85-99. (In Russ.) doi:10.20514/2226-6704-2018-8-2-85-99.

3. Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data met analysis. Eur. Heart J. 2012;33(14):1750e7. doi:10.1093/eurheartj/ehr254.

4. Hummel SL, Pauli NP, Krumholz HM, et al. Thirty-day outcomes in Medicare patients with heart failure at heart transplant centers. Circ Heart Fail. 2010;3(2):244-52. doi:10.1161/CIRCHEARTFAILURE.109.884098.

5. Drapkina OM, Boytsov SA, Omelyanovskiy VV, et al. Socio-economic impact of heart failure in Russia. Russian Journal of Cardiology. 2021;26(6):4490. (In Russ.) doi:10.15829/1560-4071-2021-4490.

6. McMurray JJ, Packer M, Desai AS, et al. PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371(11):993-1004. doi:10.1056/NEJMoa1409077.

7. Packer M, Anker SD, Butler J, et al. EMPEROR-Reduced Trial Investigators. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-24. doi:10.1056/NEJMoa2022190.

8. McMurray JJV, Solomon SD, Inzucchi SE, et al. DAPA-HF Trial Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi:10.1056/NEJMoa1911303.

9. Bokeria LA, Gudkova RG. Cardiovascular surgery — 2011. Diseases and congenital anomalies of the circulatory system. Thoracic and cardiovascular surgery. 2012;6:24-57. (In Russ.) EDN RSGNGT.

10. Tolpygina SN, Zagrebelny AV, Chernysheva MI, et al. Long-term survival of patients after cerebrovascular accident with prior coronary artery disease: data from the outpatient stage of REGION-M registry. Cardiovascular Therapy and Prevention. 2022;21(8):3288. (In Russ.) doi:10.15829/1728-8800-2022-3288.

11. Boytsov SA, Shakhnovich RM, Erlikh AD, et al. Registry of Acute Myocardial Infarction. REGION-MI — Russian Registry of Acute Myocardial Infarction. Kardiologiia. 2021;61(6):41-51. (In Russ.) doi:10.18087/cardio.2021.6.n1595.

12. Chiang CE, Naditch-Brûlé L, Murin J, et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ Arrhythm Electrophysiol. 2012;5(4):632-9. doi:10.1161/CIRCEP.112.970749.

13. Korobov VV, Akberov RF, Sharafeev AZ, Makhmutov RF. Experience in the use of endovascular methods of treatment in patients with coronary heart disease. Kazan Medical Journal. 2006;87(6):423-8. (In Russ.) EDN KZVZGH.

14. Mareev VYu, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. (In Russ.) doi:10.18087/cardio.2475.

15. Fomin IV. Chronic heart failure in russian federation: what do we know and what to do. Russian Journal of Cardiology. 2016;(8):7-13. (In Russ.) doi:10.15829/1560-4071-2016-8-7-13.

16. Bassi NS, Ziaeian B, Yancy CW, et al. Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure. JAMA Cardiol. 2020;5(8):948-51.

17. Diaby V, Adunlin G, Montero AJ. Survival modeling for the estimation of transition probabilities in model-based economic evaluations in the absence of individual patient data: a tutorial. Pharmacoeconomics. 2014;32(2):101-8.