economic evaluation of sacubitril/valsartan in chronic heart failure patients: a markov model analysis in iran

Background: sacubitril/valsartan (sac-val) is recommended for patients with heart failure (hf) and reduced ejection fraction (hfref). this study aimed to evaluate the cost-effectiveness of sac/val in chronic hf patients in iran.methods: a markov model was constructed to assess the cost-effectiveness of sac/val and enalapril from a healthcare perspective over a 15-year time horizon. the primary outcome was the incremental cost-effectiveness ratio (icer), expressed as cost per quality-adjusted life year (qaly). a discount rate of 3.5% was applied to both costs and outcomes, and a probabilistic sensitivity analysis was performed to evaluate the robustness of the results.results: the average costs of treating hf patients with sac/val and enalapril were 22,132,050,140 irr (usd 77,442.3) and 143,043,859 irr (usd 500.52), respectively, whereas the corresponding qaly values were 5.37 and 3.30, respectively. sac/val was more expensive and more effective than enalapril. the icer was 10,635,189,214 irr per qaly (37.06 usd/qaly), which was higher than the who-recommended threshold in terms of gross domestic product per capita in 2022. sac/val had a significant impact on increasing the qaly for hfref patients. at the proposed price, the cost per qaly value for sac/val exceeded the recommended threshold for the country.conclusion: considering the country's economic context, negotiating lower prices for sac/val would bring it to the top of the priority list for health services.