Budget Impact Analysis of Sacubitril Valsartan in the Treatment of Heart Failure and Reduced Ejection Fraction (HFrEF) in Indonesia

  • Erna Kristin Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada
  • Dwi Endarti Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta 55281
  • Ratih Puspita Febrinasari Department of Pharmacology, Faculty of Medicine, Universitas Sebelas Maret
  • Dwi Aris Agung Nugrahaningsih Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada
  • Woro Rukmi Pratiwi Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada
Keywords: sacubitril/valsartan, heart failure, budget impact analysis, reduced ejection fraction


Based on PARADIGM-HF Clinical Trials, LCZ696 a dual-acting sodium supramolecular complex currently known as sacubitril/valsartan was superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF) in patients with heart failure and reduced ejection fraction (HFrEF). This analysis aimed to estimate the budget impact of sacubitril/valsartan in the treatment of HFrEF in Indonesia setting. A budget impact model estimated the impact with and without use of sacubitril/valsartan for a 5-year horizon (2020 – 2024). The local data inputted in the model were including age prevalence rates, drugs costs, HF hospitalization cost, and adverse events costs. The drug cost calculation of sacubitril/valsartan was from regular price, while drugs costs of standard care were mostly coming from e-catalogue price which was reimbursement cost. The budget impact was estimated from the difference budget in which the target population is treated with the current therapy (without sacubitril/valsartan) and the future scenario in which the target population is treated with sacubitril/valsartan based on a market penetration rate of 6%, 12%, 18%, 24%, and 31% in the first, second, third, fourth and fifth years, respectively. Given the number of patients eligible for treatment was estimated as 86,594 in the first year and assumption of annual increase of HF prevalence was 1.1% based on population growth, about 1,350 deaths and 3,512 hospitalizations may be avoided over 5 years. The scenario of implementing sacubitril/valsartan for HF treatment had an impact of additional budget of 1%, 2%, 3%, 4%, 5% over 5-year horizon compared to current therapy strategy and cumulative budget impact as IDR 735 Billion over 5 years. This analysis provides an estimation of the impact of sacubitril/valsartan application in the treatment of patients with HF and reduced ejection fraction as input for Indonesia healthcare payer in implementing the strategy for HF treatment. 


Afonso-Silva, M., & Laires, P. A. (2020). PCV6 Sacubitril/Valsartan and Its IMPACT on Sudden Death in Heart Failure Patients in Portugal. Value in Health, 23(December 2020), S487. https://doi.org/10.1016/j.jval.2020.08.497
Ambrosy, A. P., Fonarow, G. C., Butler, J., Chioncel, O., Greene, S. J., Vaduganathan, M., Nodari, S., Lam, C. S. P., Sato, N., Shah, A. N., & Gheorghiade, M. (2014). The global health and economic burden of hospitalizations for heart failure: Lessons learned from hospitalized heart failure registries. Journal of the American College of Cardiology, 63(12), 1123–1133. https://doi.org/10.1016/j.jacc.2013.11.053
Bianculli, P., Volman, S., Barbeau, M., MacPherson, A., Haroun, R., & Giorgi, M. (2017). Potential Mortality Reduction With Optimal Usage of Sacubitril/Valsartan Therapy for The Treatment of Heart Failure In Argentina. Value in Health, 20(9), A918. https://doi.org/10.1016/j.jval.2017.08.2853
Bui, A. L., Horwich, T. B., & Fonarow, G. C. (2011). Epidemiology and risk profile of heart failure. Nature Reviews Cardiology, 8(1), 30–41. https://doi.org/10.1038/nrcardio.2010.165
Cariou, C., Duteil, E., Sion, M., Mahieu, N., Duco, J., & Achouba, A. (2017). Budget Impact Analysis of Sacubitril/Valsartan Introduction For Heart Failure Treatment From The French Hospital Perspective. Value in Health, 20(9), A607. https://doi.org/10.1016/j.jval.2017.08.1185
Chin, K. L., Zomer, E., Wang, B. H., & Liew, D. (2020). Cost-Effectiveness of Switching Patients With Heart Failure and Reduced Ejection Fraction to Sacubitril/Valsartan: The Australian Perspective. Heart Lung and Circulation, 29(9), 1310–1317. https://doi.org/10.1016/j.hlc.2019.03.007
Correale, M., Monaco, I., Ferraretti, A., Tricarico, L., Padovano, G., Formica, E. S., Tozzi, V., Grazioli, D., Di Biase, M., & Brunetti, N. D. (2019). Hospitalization cost reduction with sacubitril-valsartan implementation in a cohort of patients from the Daunia Heart Failure Registry. IJC Heart and Vasculature, 22, 102–104. https://doi.org/10.1016/j.ijcha.2018.12.009
Gandjour, A., & Ostwald, D. A. (2018). Sacubitril/Valsartan (LCZ696): A Novel Treatment for Heart Failure and its Estimated Cost Effectiveness, Budget Impact, and Disease Burden Reduction in Germany. PharmacoEconomics, 36(10), 1285–1296. https://doi.org/10.1007/s40273-018-0688-4
Gaziano, T. A., Fonarow, G. C., Velazquez, E. J., Morrow, D. A., Braunwald, E., & Solomon, S. D. (2020). Cost-effectiveness of Sacubitril-Valsartan in Hospitalized Patients Who Have Heart Failure with Reduced Ejection Fraction. JAMA Cardiology, 5(11), 1236–1244. https://doi.org/10.1001/jamacardio.2020.2822
Huitema, A. A., Daoust, A., Anderson, K., Poon, S., Virani, S., White, M., Rojas-Fernandez, C., Zieroth, S., & McKelvie, R. S. (2020). Optimal Usage of Sacubitril/Valsartan for the Treatment of Heart Failure: The Importance of Optimizing Heart Failure Care in Canada. CJC Open, 2(5), 321–327. https://doi.org/10.1016/j.cjco.2020.03.015
Kooli, A., Ammar, A., Burke, J., Trueman, D., Woodcock, F., & Cristino, J. (2018). Effectiveness of Sacubitril/Valsartan Versus Enalapril In Reducing Mortality and Hospitalizations Costs From A Moroccan Hospital Perspective. Value in Health, 21(Supplement 3), S100.
McMurray, J. J. V, Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., Rouleau, J. L., Shi, V. C., Solomon, S. D., Swedberg, K., & Zile, M. R. (2014). Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure. New England Journal of Medicine, 371(11), 993–1004. https://doi.org/10.1056/NEJMoa1409077
Ministry of Health of Indonesia. (2014). Basic Health Research (RISKESDAS) 2013. https://www.litbang.kemkes.go.id/laporan-riset-kesehatan-dasar-riskesdas/
National Statistics Bureau of Indonesia. (2019). Indonesian Population. https://www.bps.go.id/
O’Brien, S., Sweeney, C., & Carney, P. (2018). Pcv105 - Potential Reduction in Mortality and Hospitalisations With Optimal Usage of Sacubitril/Valsartan Therapy for the Treatment of Heart Failure With Reduced Ejection Fraction in Ireland. Value in Health, 21(October), S110. https://doi.org/10.1016/j.jval.2018.09.650
Park, S. K., Hong, S. H., Kim, H. J., Kim, S., & Lee, E. K. (2019). Cost-Utility Analysis of Sacubitril/Valsartan Use Compared With Standard Care in Chronic Heart Failure Patients With Reduced Ejection Fraction in South Korea. Clinical Therapeutics, 41(6), 1066–1079. https://doi.org/10.1016/j.clinthera.2019.04.031
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V. P., Jankowska, E. A., Jessup, M., Linde, C., Nihoyannopoulos, P., Parissis, J. T., Pieske, B., Riley, J. P., Rosano, G. M. C., Ruilope, L. M., Ruschitzka, F., … Van Der Meer, P. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiologia Polska, 74(10), 1037–1147. https://doi.org/10.5603/KP.2016.0141
Rojas, R., Balmaceda, C., Vargas, C., & Espinoza, M. (2016). Budget Impact Analysis of Sacubitril/Valsartan Versus Angiotensin-Converting-Enzyme Inhibitor for The Treatment of Heart Failure From Public Health Perspective in Chile. Value in Health, 19(7), A643–A644. https://doi.org/10.1016/j.jval.2016.09.1711
Smith, D. G., Frech-Tamas, F., Randle, W., & Preblick, R. (2007). Estimated cost savings associated with the use of valsartan in heart failure in a large US health plan. Journal of Medical Economics, 10(3), 229–238. https://doi.org/10.3111/13696990701438645
Zyryanov, S. K., Cheberda, A. E., & Belousov, D. Y. (2018). Pharmacoeconomic analysis of chronic heart failure drug therapy in patients with comorbid conditions. Rational Pharmacotherapy in Cardiology, 14(2), 167–175. https://doi.org/10.20996/1819-6446-2018-14-2-167-175
How to Cite
Kristin, E., Endarti, D., Febrinasari, R. P., Nugrahaningsih, D. A. A., & Pratiwi, W. R. (2022). Budget Impact Analysis of Sacubitril Valsartan in the Treatment of Heart Failure and Reduced Ejection Fraction (HFrEF) in Indonesia. Indonesian Journal of Pharmacy, 33(1), 83-92. https://doi.org/10.22146/ijp.2529
Research Article