NICE 'green light' for Novartis' Entresto

In guidance published today, drug cost-effectiveness watchdog for England and Wales, the National Institute for Health and Clinical Excellence (NICE), has recommended that Swiss pharma giant Novartis’ (NOVN:VX) new heart failure drug Entresto (sacubitril valsartan), the first drug of its kind, as an option for some people with heart failure.

The guidance recommends the £3 ($4.32) per day treatment for this life-threatening condition in over 100,000 people with moderate to very severe symptoms whose heart is only able to pump a reduced amount of oxygenated blood around the body (known as a reduced ejection fraction, and whose heart failure is not controlled by the commonly-used drugs, ACE inhibitors or ARBs.

The NICE Appraisal Committee considered that, given the innovative nature of Entresto, the most plausible incremental cost-effectiveness ratio (ICER) of £29,500 and £30,100 per Quality Adjusted Life Year (QALY) gained for sacubitril valsartan compared with ACE inhibitors and ARBs (for people in whom an ACE inhibitor is unsuitable), respectively, represented a cost effective use of NHS resources.

The Committee concluded that sacubitril valsartan is an innovative drug that offers the potential to prevent deaths and reduce the more than 30,000 hospital admissions for this condition each year in England. It is the first of a new kind of drug called angiotensin receptor neprilysin inhibitors. These work by widening the blood vessels, increasing blood flow while reducing blood pressure and taking the strain off the heart.

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“ACE inhibitors have been the initial gold standard treatment for chronic heart failure for almost 25 years. However, for some people their symptoms persist despite them being on the maximum dose. The committee heard from clinical experts and patient experts that a new treatment option would provide hope and generate optimism, commented Carole Longson, director of the NICE Health Technology Centre, but adding: “There was not enough evidence to show the clinical and cost effectiveness of sacubitril valsartan in people who do not have such a severely reduced ejection fraction, or in people who have very mild symptoms, and for people who have not already had an ACE inhibitor or ARB, so the committee weren’t able to recommend the drug for these people.”

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