Dr Derek Chew on the VICTORIA Trial and the Cost-effectiveness of Vericiguat

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

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


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

It’s the wholesale acquisition cost (WAC). It's actually similar to the price listed on drugs.com and goodtreatment.com. We were using that cost as part of the base case analysis and then, as part of subsequent sensitivity analyses, we'll be exploring how changes in costs actually impact the cost-effectiveness.

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

It actually is in the range of the ICERs [incremental cost-effectiveness ratios] quoted by 2 cost-effectiveness analyses of [sodium glucose co-transporter 2] inhibitors, such as dapagliflozin. Those analyses, the modeling approach was slightly different. So, limitations aside in terms of different methodology, they're all around the ballpark of $60,000 to $70,000 per QALY [quality-adjusted life year] gained, so quite similar.

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

Our analysis actually included vericiguat as an add-on therapy, on basis of the baseline characteristics of the VICTORIA trial itself. And in that trial, I guess at that time, 3 quarters of people are on [angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers] ACE inhibitors/ARBs, a quarter were on sacubitril/valsartan, no comments on SGLT2 inhibitors, and I think 3 quarters were also on [mineralocorticoid receptor antagonists] MRAs as well.