Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction

Abstract

IMPORTANCE Heart failure with reduced ejection fraction produces substantial morbidity, mortality, and health care costs. Dapagliflozin is the first sodium-glucose cotransporter 2 inhibitor approved for the treatment of heart failure with reduced ejection fraction.OBJECTIVE To examine the cost-effectiveness of adding dapagliflozin to guideline-directed medical therapy for heart failure with reduced ejection fraction in patients with or without diabetes. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation developed and used a Markov cohort model that compared dapagliflozin and guideline-directed medical therapy with guidelinedirected medical therapy alone in a hypothetical cohort of US adults with similar clinical characteristics as participants of the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) trial. Dapagliflozin was assumed to cost $4192 annually. Nonparametric modeling was used to estimate long-term survival. Deterministic and probabilistic sensitivity analyses examined the impact of parameter uncertainty. Data were analyzed between September 2019 and January 2021. MAIN OUTCOMES AND MEASURES Lifetime incremental cost-effectiveness ratio in 2020 US dollars per quality-adjusted life-year (QALY) gained. RESULTS The simulated cohort had a starting age of 66 years, and 41.8% had diabetes at baseline. Median (interquartile range) survival in the guideline-directed medical therapy arm was 6.8 (3.5-11.3) years. Dapagliflozin was projected to add 0.63 (95% uncertainty interval [UI], 0.25-1.15) QALYs at an

Economic Evaluation of Dapagliflozin in the Treatment of Patients With Heart Failure: A Systematic Review

“…Eight articles were removed, primarily because they were commentaries (n = 2), no economic evaluation (n = 1), incomplete data (n = 2), not heart failure (n = 1), repeated publication (n = 1), and full text was not available (n = 1). Finally, eight articles were selected in this systematic review ( McEwan et al, 2020 ; Yao et al, 2020 ; Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Liao et al, 2021 ; Mendoza et al, 2021 ; Parizo et al, 2021 ; Savira et al, 2021 ). More details of the retrieval process are shown in Figure 1 .…”

“…The time horizon of most of the studies was a lifetime (n = 6) ( McEwan et al, 2020 ; Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Mendoza et al, 2021 ; Parizo et al, 2021 ; Savira et al, 2021 ), and the remaining two studies were 15 years ( Yao et al, 2020 ; Liao et al, 2021 ). Six studies used 1-year Markov cycles, and one study used 3-month Markov cycles, while one study however adopted 1-month Markov cycles.…”

“…Six studies used 1-year Markov cycles, and one study used 3-month Markov cycles, while one study however adopted 1-month Markov cycles. Half of the eight studies were performed using the perspective of health care (n = 4) ( Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Liao et al, 2021 ; Savira et al, 2021 ), health care payer (n = 2) ( Isaza et al, 2021 ; Parizo et al, 2021 ), health care provider (n = 1) ( Parizo et al, 2021 ), or payers perspective ( McEwan et al, 2020 ). None of the included studies was conducted from the social perspective.…”

“…Furthermore, none of the included studies had considered additional country epidemiological data to adjust clinical endpoints derived from the trial. Six studies used a discount rate of 3% for costs and outcomes ( McEwan et al, 2020 ; Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Liao et al, 2021 ; Mendoza et al, 2021 ; Parizo et al, 2021 ), whereas Savira et al ( Savira et al, 2021 ) and Yao et al ( Yao et al, 2020 ) used 5% and 4.2%, respectively. More details are shown in Table.1 .…”

“…Two studies applied two-way sensitivity analyses on the basis of the preceding two sensitivity analyses ( Yao et al, 2020 ; Parizo et al, 2021 ). Six studies reported that the ICERs were mainly influenced by the cost of dapagliflozin ( Yao et al, 2020 ; Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Liao et al, 2021 ; Mendoza et al, 2021 ; Parizo et al, 2021 ), Yao et al (2020) found that the ICER ($12,696 per QALY gained) was higher than the per capita Gross Domestic Product for China in 2017 ($8,573) when the cost of dapagliflozin was at its upper limit, which made the cost of dapagliflozin become the most influential factor on the ICER. Mendoza et al (2021) showed that the dapagliflozin in treatment for patients was not cost effective when the unit cost of dapagliflozin was PHP46.50, but it would be cost effective when the cost was PHP44.00.…”