Abstract 9946: Dapagliflozin versus Empagliflozin for Improving Outcomes of Type 2 Diabetes Mellitus Patients with Heart Failure and Reduced Ejection Fraction

Abstract

Introduction: The co-morbidity of chronic heart failure and Type 2 diabetes mellitus (DM) is associated with a very high risk for CVmortality and HF-related hospitalizations (HHF). The Sodium-Glucose Transport protein 2 inhibitors (SGLT2i) dapagliflozin and empagliflozin improve the outcomes of this patient population. We aimed to compare their value for money for this indication. Hypothesis: Empagliflozin and dapagliflozin have comparable value for money for improving the HF outcomes of patients with HFrEF and DM. Methods: SGLT2i data was extracted from published results of empagliflozin and dapagliflozin in the subgroups of patients with co-morbidity of DM. The clinical outcome measure was HHF or CV mortality events. The economic measure was the cost needed to treat (CNT) to prevent one event, calculated by multiplying the one-year number needed to treat (NNT) to prevent one event by the annual cost of each therapy. Drug costs were based on the 2021 US National Average Drug Acquisition Cost prices. Secondary outcomes were the CNT to prevent one event of HHF and CV mortality as separate clinical outcomes. Sensitivity analysis was performed to mitigate differences between the trial’s populations Results: Treatment with empagliflozin in EMPEROR-REDUCED has resulted in an NNT of 17 (95% CI: 12-36) compared to 24 (95% CI: 16-60) with dapagliflozin in DAPA-HF. Accordingly the cost needed to treat to prevent one event of CVM or HHF was $81,550 (95% CI: $57,565-$172,694) and $108,563 (95% CI: $72,376-$271,408), respectively. The sensitivity analysis confirmed the primary results. The CNT to prevent CV mortality events is significantly lower with dapagliflozin and prevent HHF significantly lower with empagliflozin (Fig. 1). Conclusions: Empagliflozin and dapagliflozin have comparable value for money for improving HF outcomes of patients with HFrEF, with an advantage for dapagliflozin in CV mortality and for empagliflozin in preventing HHF.