Cost effectiveness analyses of pharmacological treatments in heart failure

Abstract

In a rapidly growing and aging population, heart failure (HF) has become recognised as a public health concern that imposes high economic and societal costs worldwide. HF management stems from the use of highly cost-effective angiotensin converting enzyme inhibitors (ACEi) and β-blockers to the use of newer drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i), ivabradine, and vericiguat. Modelling studies of pharmacological treatments that report on cost effectiveness in HF is important in order to guide clinical decision making. Multiple cost-effectiveness analysis of dapagliflozin for heart failure with reduced ejection fraction (HFrEF) suggests that it is not only cost-effective and has the potential to improve long-term clinical outcomes, but is also likely to meet conventional cost-effectiveness thresholds in many countries. Similar promising results have also been shown for vericiguat while a cost effectiveness analysis (CEA) of empagliflozin has shown cost effectiveness in HF patients with Type 2 diabetes. Despite the recent FDA approval of dapagliflozin and empagliflozin in HF, it might take time for these SGLT2i to be widely used in real-world practice. A recent economic evaluation of vericiguat found it to be cost effective at a higher cost per QALY threshold than SGLT2i. However, there is a lack of clinical or real-world data regarding whether vericiguat would be prescribed on top of newer treatments or in lieu of them. Sacubitril/valsartan has been commonly compared to enalapril in cost effectiveness analysis and has been found to be similar to that of SGLT2i but was not considered a cost-effective treatment for heart failure with reduced ejection fraction in Thailand and Singapore with the current economic evaluation evidences. In order for more precise analysis on cost effectiveness analysis, it is necessary to take into account the income level of various countries as it is certainly easier to allocate more financial resources for the intervention, with greater effectiveness, in high- and middle-income countries than in low-income countries. This review aims to evaluate evidence and cost effectiveness studies in more recent HF drugs i.e., SGLT2i, ARNi, ivabradine, vericiguat and omecamtiv, and gaps in current literature on pharmacoeconomic studies in HF.

Disparities in therapies for coronary artery disease with reduced left ventricular ejection fraction

“…were not yet part of standard OMT [17,18] . Furthermore, the Swedish Coronary Angiography and Angioplasty registry (SCAAR) [19] evaluated long-term outcomes in patients with ischemic heart failure with LVEF < 50% who underwent either PCI or CABG.…”

SGLT2 inhibitors for patients with heart failure with preserved ejection fraction in China: a cost-effectiveness study

“…Evidence-based medicine has found that sodium, glucose cotransporter 2 inhibitor (SGLT2i), sacubitril/valsartan (SAC/ VAL), ivabradine, vericiguat and omecamtiv may show considerable benefits for HFrEF (Lim et al, 2022), but HFpEF remains an important unmet field and effective treatment for patients remains unsolved. Empagliflozin and dapagliflozin have become the preferred drugs that have provided potential benefits to patients with HFpEF in recent years (Anker et al, 2021;Solomon et al, 2022).…”

Cost-effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for Patients with Heart Failure in China: a new pillar in our pockets, but at what price?

“…Cost-effectiveness analysis is useful to examine costs and health outcomes of one or more interventions, by comparing one intervention with another (or to the standard of care) and approximating the costs required to gain a unit of a health outcome as a life year gained or a death prevented. 8 Therefore, cost-effectiveness helps identify ways to redirect economic resources by demonstrating not only the benefit of allocating them to effective interventions but also the utility of choosing more costeffective interventions. 8 The analysis was performed according to China's health care perspective.…”

“…8 Therefore, cost-effectiveness helps identify ways to redirect economic resources by demonstrating not only the benefit of allocating them to effective interventions but also the utility of choosing more costeffective interventions. 8 The analysis was performed according to China's health care perspective. 7 As the first step, the authors conducted a meta-analysis, pooling the results of 6 pivotal studies in the field.…”

“…8 Therefore, cost-effectiveness helps identify ways to redirect economic resources by demonstrating not only the benefit of allocating them to effective interventions but also the utility of choosing more cost-effective interventions. 8…”