Real-World Cost-Effectiveness of Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure With Reduced Ejection Fraction in Korea

초록

OBJECTIVE: Heart failure with reduced ejection fraction (HFrEF) poses a significant burden on healthcare systems worldwide. We evaluated the real-world cost-effectiveness of angiotensin receptor-neprilysin inhibitor (ARNI) compared with traditional renin-angiotensin system (RAS) blockade in patients with HFrEF in the Korean setting. METHODS: A partitioned survival model was developed based on the PARADE-HF study, which evaluated the effectiveness of ARNI in Korean HFrEF patients using National Health Insurance claims data. The model estimated medical costs, hospitalizations, life-years, and quality-adjusted life-years (QALYs) over a lifetime. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). RESULTS: The use of ARNI resulted in additional 0.54 life-years, 0.25 QALYs gained, fewer hospitalizations (25.91 vs. 26.40) per 1,000 person-years, and an added cost of $2,880perpatient.TheICERwas$11,365/QALY for all patients and 9,421/QALY for elderly patients (≥75 years). At a20,000/QALY threshold of the willingness to pay, cost-effectiveness probabilities were 68% in all patients and 88% in elderly patients. CONCLUSIONS: In the real world, ARNI demonstrated superior cost-effectiveness compared with traditional RAS blockade in patients with HFrEF, with particularly pronounced benefits in elderly patients aged ≥75 years. The favorable cost-effectiveness profile, combined with significant reductions in mortality and hospitalization, supports the broader adoption of ARNI in clinical practice, especially for elderly patients despite concerns about tolerability in this population. Copyright © 2025. The Korean Society of Cardiology.

키워드