Cost-Utility Analysis of Add-On Vericiguat to Standard Treatment in Thai Patients With Heart Failure and Reduced Ejection Fraction

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OBJECTIVES: This study aimed to evaluate the cost-utility of adding vericiguat to standard-of-care therapy for patients with heart failure with reduced ejection fraction (HFrEF) and worsening heart failure (HF) events in the context of Thailand's healthcare system. METHODS: A Markov model using Microsoft Excel was conducted to simulate the lifetime economic outcomes of adding vericiguat to standard-of-care therapy (SoCT) compared with SoCT alone for Thai patients with HFrEF. Model parameters were derived from the VICTORIA trial and supplemented with local data on healthcare costs and utilities. Sensitivity, subgroup, and threshold analyses were also performed. RESULTS: Adding vericiguat to SoCT increased total life-years (LYs) from 5.80 to 5.98 and quality-adjusted life-years (QALYs) from 2.74 to 2.85. However, it also increased total lifetime costs by 114 740 THB ($3114) per patient compared with SoCT alone, resulting in an incremental cost-effectiveness ratio of 1 063 375 THB ($28 857) per QALY gained. Subgroup analysis based on NT-proBNP levels demonstrated that vericiguat had a more favorable incremental cost-effectiveness ratio of 557 427 THB ($15 127) per QALY gained in patients with NT-proBNP ≤ 4000 pg/mL. Considering the current willingness-to-pay threshold of 160 000 THB ($4342) per QALY gained in Thailand, vericiguat did not meet the cost-effectiveness criteria. CONCLUSIONS: Despite its clinical benefits in reducing HF hospitalizations and cardiovascular mortality, vericiguat as an adjunct to SoCT for patients with HFrEF in Thailand exceeds the accepted cost-effectiveness threshold of 4342 USD/QALY gained. A price reduction of 90.2% would be necessary to achieve the current Thai willingness-to-pay threshold.

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