Dr Derek Chew on the VICTORIA trial and the cost-effectiveness of Vericiguat

The VICTORIA study found that vericiguat was more cost effective than placebo when using current societal benchmarks for the value of healthcare in the United States. Derek Chew, MD, now an assistant professor at the University of Calgary, conducted economic evaluations for the VICTORIA trial while working for the Duke Clinical Research Institute. The results were presented at the scientific sessions of the AHA 2021. Here he explains why vericiguat is more cost-effective for patients with heart failure with a reduced ejection fraction.

Derek Chew, MD, assistant professor at the University of Calgary, clinical electrophysiologist and applied health economist, works with the health economics team at Duke Clinical Research Institute. The VICTORIA trial, which investigated vericiguat treatment for heart failure patients with reduced ejection fraction, was presented at the 2021 American Heart Association Scientific Sessions. Vericiguat has proven to be a cost-effective treatment, explains Dr. Chew.


You noted a cost of $ 19.41 [per day WAC]. When was this number obtained for the calculation?

This is the Wholesale Acquisition Cost (WAC). It’s actually similar to the price listed on drug.com and goodtreatment.com. We used this cost as part of the baseline scenario analysis, and then, as part of subsequent sensitivity analyzes, we will explore the actual impact of cost changes on profitability.

Vericiguat was well below the ICER QALY threshold. How does it compare to SGLT2 inhibitors and other therapies that may be considered?

It is in fact in the range of ICER [incremental cost-effectiveness ratios] cited by 2 cost-effectiveness analyzes of [sodium glucose co-transporter 2] inhibitors such as dapagliflozin. These analyzes, the modeling approach was slightly different. So apart from the limitations in terms of different methodology, they are around $ 60,000 to $ 70,000 per QALY [quality-adjusted life year] won, so quite similar.

Assuming patients are sick enough already and vericiguat is added to other therapies, how does this affect the cost-effectiveness equation?

Our analysis actually included vericiguat as an adjunct, based on the baseline characteristics of the VICTORIA trial itself. And in this trial, I guess at that point, three quarters of the people are under [angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers] ACE / ARB inhibitors, a quarter were on sacubitril / valsartan, no comments on SGLT2 inhibitors, and I believe 3 quarters were also on [mineralocorticoid receptor antagonists] ARMs too.

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