Heart failure with reduced ejection fraction (HFrEF) poses significant challenges in its management, but recent research has shed light on potential treatment strategies.

Quadruple therapy, comprising SGLT2 inhibitors, angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, and mineralocorticoid receptor antagonist (MRA), is being considered as a promising approach. In this article, we delve into the cost-effectiveness of quadruple therapy and its implications for patients with HFrEF.

A comprehensive cost-effectiveness analysis was conducted to compare different treatment strategies for HFrEF. Researchers evaluated quadruple therapy with beta-blockers, MRA, ARNI, and SGLT2 inhibition against triple therapy, therapy with SGLT2 inhibition alone, and standard care with enalapril. The analysis considered discounted costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios to assess the value of quadruple therapy.

The study findings indicated that quadruple therapy was narrowly cost-effective for patients with HFrEF. Although the addition of SGLT2 inhibitors and ARNI improved outcomes, the high cost of these medications raised affordability concerns. The estimated incremental cost-effectiveness ratio and additional QALYs provided insights into the value proposition of quadruple therapy compared to other treatment options.

The rising cost of SGLT2 inhibitors and ARNI has raised concerns about accessibility and affordability. From 2015, the average price per unit for these medications has significantly increased, putting a financial burden on patients. The potential impact of Medicare drug price negotiation, as outlined in the Inflation Reduction Act, is discussed, highlighting the importance of considering lower drug prices to achieve cost-effective management of HFrEF.

Medicare’s drug price negotiation under the Inflation Reduction Act of 2022 has the potential to influence the accessibility and affordability of HFrEF medications. The study suggests that Medicare’s collective market share and negotiated price ceilings could lead to substantial discounts for SGLT2 inhibitors and ARNI. Considering these factors is crucial when assessing the cost-effectiveness and long-term implementation of quadruple therapy.

Quadruple therapy presents a promising approach in the treatment of HFrEF. By combining multiple medications targeting different aspects of the condition, it offers the potential for improved patient outcomes. However, the cost-effectiveness and affordability of this approach must be carefully evaluated, and collaboration between healthcare stakeholders, policymakers, and pharmaceutical companies is crucial to ensure optimal implementation and access to life-saving therapies.