Abstract
Objective: To evaluate the economics and effectiveness of adding dapagliflozin or empagliflozin to the standard treatment for heart failure (HF) for patients with reduced ejection fraction (HFrEF) in China. Methods: A Markov model was developed to project the clinical and economic outcomes of adding dapagliflozin or empagliflozin to the standard treatment for 66-year-old patients with HFrEF. A cost-utility analysis was performed based mostly on data from the empagliflozin outcome trial in patients with chronic heart failure and a reduced ejection fraction (EMPEROR-Reduced) study and the dapagliflozin and prevention of adverse outcomes in heart failure (DAPA-HF) trial. The primary outcomes were measured via total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Results: In China, compared to the standard treatment, although adding dapagliflozin to the standard treatment in the treatment of HFrEF was more expensive ($4,870.68 vs. $3,596.25), it was more cost-effective (3.87 QALYs vs. 3.64 QALYs), resulting in an ICER of $5,541.00 per QALY. Similarly, adding empagliflozin was more expensive ($5,021.93 vs. $4,118.86) but more cost-effective (3.66 QALYs vs. 3.53 QALYs), resulting in an ICER of $6,946.69 per QALY. A sensitivity analysis demonstrated the robustness of the model in identifying cardiovascular death as a significant driver of cost-effectiveness. A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per QALY, the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively. A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on ICER. Conclusion: Compared with standard treatments with or without empagliflozin, adding dapagliflozin to the standard treatment in the treatment of HFrEF in China was extremely cost-effective.
Highlights
Heart failure (HF) is a serious clinical manifestation or a terminal stage of various heart diseases and has become an increasingly serious global public health problem (Conrad et al, 2018; Gu et al, 2003)
A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per quality-adjusted life years (QALYs), the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively
A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on incremental costeffectiveness ratio (ICER)
Summary
Heart failure (HF) is a serious clinical manifestation or a terminal stage of various heart diseases and has become an increasingly serious global public health problem (Conrad et al, 2018; Gu et al, 2003). The prevalence of HF in China has increased to approximately 2%, and there are approximately 8–10 million patients experiencing HF (The US Centers for Disease Control and Prevention, 2016). The Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction (EMPEROR-Reduced) study and the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study found that both dapagliflozin and empagliflozin can reduce the risk of CV death or hospitalization in HFrEF patients with or without T2DM (Mcmurray et al, 2019; Packer et al, 2020). The Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved) study found that empagliflozin could be effective for heart failure with preserved ejection fraction (HFrEF) The United States Food and Drug Administration (FDA) announced that dapagliflozin and empagliflozin could be used for the treatment of HFrEF
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