Cost-Effectiveness of Sacubitril/Valsartan Compared to Enalapril in Patients with Heart Failure and Reduced Ejection Fraction (HFrEF): a Systematic Review of Model Based Economic Evaluations

DOI

10.2991/978-94-6239-762-0_5How to use a DOI?

Keywords

Sacubitril/Valsartan; Cost-Effectiveness; ICER; Hfref; Markov Model; QALY; Economic Evaluation

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a major global health and economic challenge. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has demonstrated superior clinical efficacy compared to enalapril, but its cost-effectiveness across different economic settings remains uncertain. This study aimed to systematically review and synthesize full cost-utility evaluations comparing sacubitril/valsartan with enalapril in HFrEF patients, focusing on incremental cost-effectiveness ratios (ICERs) and country-specific willingness-to-pay (WTP) thresholds. A systematic search from 2015 to 2025 across five databases identified studies using Markov models and reporting cost per quality-adjusted life year (QALY) gained. All costs were standardized to June 2025 US dollars, and reporting quality was assessed using the CHEERS 2022 checklist. Twelve studies were included, representing high-, upper-middle-, and lower-middle-income countries. All reported ICERs were below or within national WTP thresholds, ranging from $2,214/QALY in Indonesia to $103,416/QALY in Qatar. Sacubitril/valsartan was consistently found to be cost-effective across all settings, despite heterogeneity in methodologies. However, most studies lacked considerations for equity, stakeholder involvement, and model transparency. Overall, sacubitril/valsartan represents a cost-effective option for managing HFrEF globally, and its wider adoption is supported. Future research should address equity issues, utilize real-world data, and promote open access to economic models.

Copyright

© 2026 The Author(s)

Open Access

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits any noncommercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if you modified the licensed material. You do not have permission under this license to share adapted material derived from this chapter or parts of it.

Download article (PDF)

TY  - CONF
AU  - Ina Kusuma Diana
AU  - Sri Rukayah
AU  - Puspitaningrum Inpastiarini
AU  - Nor Hamidah
AU  - Tugiyanti Tugiyanti
AU  - Dwi Endarti
AU  - Tuangrat Phodha
PY  - 2026
DA  - 2026/09/04
TI  - Cost-Effectiveness of Sacubitril/Valsartan Compared to Enalapril in Patients with Heart Failure and Reduced Ejection Fraction (HFrEF): a Systematic Review of Model Based Economic Evaluations
BT  - Proceedings of the 6th International Conference on Bioinformatics, Biotechnology, and Biomedical Engineering (BIOMIC 2025)
PB  - Atlantis Press
SP  - 65
EP  - 85
SN  - 2468-5739
UR  - https://doi.org/10.2991/978-94-6239-762-0_5
DO  - 10.2991/978-94-6239-762-0_5
ID  - Diana2026
ER  -