Cost-Effectiveness Analysis of Ivabradine in Chronic Heart Failure in the Polish Setting

To estimate cost-effectiveness of ivabradine used in treatment of chronic heart failure in Poland, using model based on individual patient data from pivotal SHIFT trial adapted using contemporary real-life epidemiology, treatment pattern and cost country-specific data. Economic model based on SHIFT trial was originally developed for the UK setting and published. Based on the model, in November 2012 NICE gave its positive guidance for the analysed technology in line with EMA registered indication, acknowledging a range of conservative assumptions. Current study utilizes the NICE model populated with most recently published local data. General mortality was estimated from Polish life tables for the year 2010. Unit cost and expected rate of hospitalizations on standard treatment was based on publication in Polish Heart Journal. Standard treatment cost was based on official listing of reimbursed drugs. Average cost of ivabradine (5mg and 7.5mg, 56 tabs) was based on popular drug database (Kamsoft, April 2013). Exchange rate of National Bank of Poland 1 EUR=4.1759 PLN was applied (May 2013). At current pharmacy price (55.60 EUR / 56 tabs), incremental cost-utility ratio for ivabradine on top of standard treatment vs standard treatment alone is estimated at 10 230 EUR / QALY, well below the official cost-effectiveness threshold defined at 3*DGP per capita (25 336 EUR). Sensitivity analysis revealed that in order to exceed the cost-effectiveness threshold, price would have to be increased to 113.60 EUR (+104%). Conservative analysis shows that ivabradine used on top of standard treatment (ACE inhibitor, beta-blocker, MR antagonist, ±diuretics) in patients suffering from chronic heart failure is a highly cost-effective health technology in the Polish setting, according to the criterion defined in Reimbursement Law. Robustness of this finding is demonstrated by the fact that cost-effectiveness is retained even at a price double vs base-case.