Abstract 12120: Cost-Effectiveness of Earlier Initiation of Sodium-Glucose Cotransporter 2 Inhibitors in Patients With a History of Heart Failure

Abstract

Background: Patients with heart failure (HF) are at increased risk after hospitalisations for HF (HHF). Timely initiation of medical therapy may reduce morbidity and mortality in these patients. The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial demonstrated that dapagliflozin reduced the risk of worsening HF and mortality when added to guideline-directed medical therapy (GDMT). Whilst previous economic evaluations have demonstrated that dapagliflozin is cost-effective; timing of initiation has not been considered. Objective: This study assessed whether early addition of dapagliflozin (D+GDMT) was cost-effective compared to a 12-month delay. Methods: A published lifetime Markov model was utilised with health states defined by Kansas City Cardiomyopathy (KCCQ) score, type 2 diabetes status and incidence of HF events. We analysed the DAPA-HF trial to estimate the incidence of HF events using a negative binomial regression model, and parametric survival analysis for all-cause death. Direct healthcare costs (2019 GBP) and utility values were sourced from the published literature and DAPA-HF, respectively. We estimated lifetime costs and quality adjusted life years (QALYs) for early initiation of D+GDMT compared to a 12-month delay. Results: Standard therapy was associated with lifetime costs of £12,641 and 4.11 QALYs. Treatment with D+GDMT with 12 months delay was associated with total discounted lifetime costs and QALYs of £15,966 and 4.71 respectively. Early initiation was associated with lifetime cost and QALYS; £16,518 and 4.78 respectively. Consequently, early initiation was associated with an additional cost of £552 and QALY gains of 0.08 resulting in an incremental cost effectiveness ratio of £8,515. Conclusion: Early or late initiation of D+GDMT is cost-effective. However, earlier initiation is associated with rapid improvement in patient symptoms leading to 10% greater QALY gains at a very attractive ICER.