Abstract 12332: Comparative Cost-Effectiveness of Sacubitril-Valsartan, Dapagliflozin, and Empagliflozin in Heart Failure With Reduced Ejection Fraction

Abstract

Introduction: The 2022 American College of Cardiology/American Heart Association (ACC/AHA) guidelines established angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors as Class I therapies in heart failure with reduced ejection fraction (HFrEF). Previous analyses have demonstrated the cost-effectiveness of these drugs, but use of different methodologies limit comparison. The objective of this study was to use a singular model to compare the cost-effectiveness of these agents in HFrEF. Methods: A 2-state Markov model was developed to compare the incremental cost-effectiveness ratios of sacubitril-valsartan, dapagliflozin, and empagliflozin. The enalapril arm of the PARADIGM-HF trial served as the control. Data from the PARADIGM-HF, DAPA-HF, and EMPEROR-Reduced trials were used to simulate treatment with sacubitril-valsartan, dapagliflozin, and empagliflozin, respectively. The model used a lifetime time horizon from a United States healthcare perspective. All costs and quality-adjusted life years were discounted 3% annually. The primary outcome was the incremental cost-effectiveness ratio of each treatment compared to control. Results: The incremental cost-effectiveness ratios of sacubitril-valsartan, dapagliflozin, empagliflozin, were $74,111, $72,048, and $118,253, respectively. Figure 1 shows the incremental cost-effectiveness ratios and incremental quality-adjusted life years in the present analysis compared to previously published analyses. Conclusions: In a singular model of patients with HFrEF, sacubitril-valsartan, dapagliflozin, and empagliflozin all met the threshold for intermediate value ($50,000-$150,000 per quality-adjusted life year gained) set by the ACC/AHA.