Introduction: Among patients with HFrEF, treatment with sacubitril/valsartan (SAC/VAL) was shown in PARADIGM-HF to reduce risks of CV death and HF hospitalization compared with enalapril; however, scarce data exist regarding the impact of SAC/VAL on real-world healthcare resource utilization (HCRU) compared to ACEI or ARB.
Objective: To compare HCRU among patients with HFrEF treated with SAC/VAL vs. ACEI or ARB.
Methods: Using managed care claims data, we identified stable adults with claims-based proxy for HFrEF and ≥1 claim for SAC/VAL (identified first), ACEI or ARB during Oct 2015 to Jun 2016. We required ≥80% proportion of days covered with SAC/VAL or ACE/ARB for first 3 months post index claim. SAC/VAL and ACEI/ARB cohorts were propensity score matched on demographics, baseline characteristics and length of follow-up. Per patient per month (PPPM) HCRU (ambulatory visit, ER visit and hospitalization) and timing of first hospitalization (including estimated failure probabilities) were calculated during a variable follow-up period (3-12 months). HF hospitalization was identified based on first-listed diagnosis code of HF on a hospital facility claim. Robust variance estimation was used to compare PPPM HCRU between matched cohorts and proportional hazards models (no covariate adjustment) were used to evaluate risk of first hospitalization.
Results: With mean (SD) follow-up of 185.0 (70.1) days, 279 patients were identified in each of the SAC/VAL cohort and matched ACEI/ARB cohort (mean [SD] age, 67.9 [12.6] years; 73.5% Medicare Advantage enrollee; 26.5% commercial enrollee; 68.1% male; 56.1% diabetes; 46.1% AF; 46.6% hospitalization in 1 year pre index claim). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, experienced lower mean (SD) PPPM all-cause ER visits (0.10 vs. 0.19, p<.001), all-cause hospitalizations (0.05 vs. 0.11, p<.001) and HF hospitalizations (0.01 vs. 0.03, p=.003), and no difference in all-cause ambulatory visits (3.13 vs. 3.24, p=.608). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, had reduced risk of first all-cause hospitalization (hazard ratio [HR]: 0.57, 95% CI: 0.42-0.77, p<.001; estimated failure probability: 1.8% and 6.5% at 1 month, 11.1% and 21.9% at 3 months, 20.7% and 33.1% at 6 months) and first HF hospitalization (HR: 0.56, 95% CI: 0.33-0.94, p=.030; estimated failure probability: 0.7% and 2.2% at 1 month, 3.2% and 8.6% at 3 months, 9.2% and 13.3% at 6 months).
Conclusions: Based on a real-world sample of patients with HFrEF, those initiated with SAC/VAL ≤12 months following US market approval experienced fewer monthly hospitalizations and ER visits compared to ACEI/ARB, and no difference in ambulatory visits. Lower risk of hospitalization after initiating SAC/VAL, rather than using ACEI/ARB, is important since HF hospitalization was previously associated with higher 30-60 day mortality and readmission rate.