Estimating the Long-Term Treatment Benefits of Sacubitril–Valsartan

Using actuarial data based on the results of the PARADIGM-HF trial, investigators found that the use of sacubitril–valsartan in patients with heart failure resulted in a mean of 1 to 2 additional years of survival, as compared with enalapril. To the Editor: Although data from clinical trials can be used to estimate the effectiveness of a new therapy as compared with a control during the study follow-up, estimating long-term treatment effects is often difficult. The PARADIGM-HF trial showed that sacubitril–valsartan was superior to enalapril in reducing the rates of death from cardiovascular causes or hospitalization for heart failure (the composite primary end point) and death from any cause among patients with heart failure and a reduced ejection fraction. 1 To estimate the long-term treatment effects of sacubitril–valsartan versus enalapril, we derived actuarial estimates of age-specific event rates and expected survival . . .