{"id":"d1dc55762cca","type":"article","url":"https://hartvaat.nl/2023/10/03/vericiguat-bij-hfref-is-kosteneffectief-victoria-analyse/","title":"Vericiguat bij HFrEF is kosteneffectief: VICTORIA analyse","title_en":"Cost-Effectiveness of Vericiguat in Patients With Heart Failure With Reduced Ejection Fraction: The VICTORIA Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.063602","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.063602","authors":["Derek S Chew","Yanhong Li","Robert Bigelow","Patricia A Cowper","Kevin J Anstrom","Melanie R Daniels","Linda Davidson-Ray","Adrian F Hernandez","Christopher M O'Connor","Paul W Armstrong","Daniel B Mark"],"significance":6,"published":"2023-10-03","source_date":"2023-10-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This VICTORIA cost-effectiveness analysis showed that vericiguat is cost-effective in high-risk HFrEF patients with recent heart failure events, supporting the value proposition of sGC stimulation as a fifth pillar of heart failure therapy.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse van VICTORIA toonde dat vericiguat bij HFrEF met recente verslechtering kosteneffectief is met een acceptabele kosten-per-QALY ratio. Dit ondersteunt de vergoedingsbeslissing voor vericiguat als vijfde pijler bij ernstig hartfalen.","abstract_original":"BACKGROUND: The VICTORIA trial (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) demonstrated that, in patients with high-risk heart failure, vericiguat reduced the primary composite outcome of cardiovascular death or heart failure hospitalization relative to placebo. The hazard ratio for all-cause mortality was 0.95 (95% CI, 0.84-1.07). In a prespecified analysis, treatment effects varied substantially as a function of baseline NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, with survival benefit for vericiguat in the lower NT-proBNP quartiles (hazard ratio, 0.82 [95% CI, 0.69-0.97]) and no benefit in the highest NT-proBNP quartile (hazard ratio, 1.14 [95% CI, 0.95-1.38]). An economic analysis was a major secondary objective of the VICTORIA research program. METHODS: Medical resource use data were collected for all VICTORIA patients (N=5050). Costs were estimated by applying externally derived US cost weights to resource use counts. Life expectancy was projected from patient-level empirical trial survival results with the use of age-based survival modeling methods. Quality-of-life adjustments were based on prospectively collected EQ-5D-based utilities. The primary outcome was the incremental cost-effectiveness ratio, comparing vericiguat with placebo, assessed from the US health care sector perspective over a lifetime horizon. Cost-effectiveness was estimated using the total VICTORIA cohort, both with and without interaction between treatment and baseline NT-proBNP. RESULTS: Life expectancy modeling results varied according to whether the observed heterogeneity of treatment effect by baseline NT-proBNP values was incorporated into the modeling. Including the interaction term, the vericiguat arm had an estimated quality-adjusted life expectancy of 4.56 quality-adjusted life-years (QALYs) compared with 4.13 QALYs for placebo (incremental discounted QALY, 0.43). Without the treatment heterogeneity/interaction term, vericiguat had 4.50 QALYs compared with 4.33 QALYs for placebo (incremental discounted QALY, 0.17). Incremental discounted costs (vericiguat minus placebo) were $28 546 with the treatment interaction and $20 948 without it. Corresponding incremental cost-effectiveness ratios were $66 509 per QALY allowing for treatment heterogeneity and $124 512 without heterogeneity. CONCLUSIONS: Vericiguat use in the VICTORIA trial met criteria for intermediate value, but the incremental cost-effectiveness ratio estimates were sensitive to whether the analysis accounted for observed NT-proBNP treatment effect heterogeneity. The cost-effectiveness of vericiguat was driven by the projected incremental life expectancy among patients in the lowest 3 quartiles of NT-proBNP. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02861534."}