Cost‐utility analysis of add‐on dapagliflozin in heart failure with preserved or mildly reduced ejection fraction

Tang, Yi; Sang, Haiqiang

doi:10.1002/ehf2.14426

Cited by 9 publications

(4 citation statements)

References 41 publications

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“…The incremental costeffectiveness ratios were £7,761, €9,540, and €5343/QALY in the United Kingdom, Germany, and Spain, respectively (Booth et al, 2023). Similarly, Tang and Sang. (2023) performed a cost-utility analysis based on the DELIVER study and the national statistical database.…”

Section: Discussionmentioning

confidence: 88%

“…(2023) performed a cost-utility analysis based on the DELIVER study and the national statistical database. The study showed that the adjunct use of dapagliflozin to standard of care among patients with HFpEF or HFmrEF was cost-effective in China at a willingness-to-pay value of $12,652.5/QALY ( Tang and Sang, 2023 ). Most recently, Cohen et al (2023) performed an economic evaluation using a simulation model of US adults with HFpEF who meet the eligibility criteria of the EMPEROR-Preserved or DELIVER trials.…”

Section: Discussionmentioning

confidence: 99%

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Dapagliflozin versus sacubitril–valsartan for heart failure with mildly reduced or preserved ejection fraction

Arbel,

Azab,

Oberoi

et al. 2024

Front. Pharmacol.

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Background and aim:Heart failure with preserved ejection fraction (HFpEF) is associated with an increased risk of heart failure (HF) hospitalizations and cardiovascular death (CVD). Both dapagliflozin and sacubitril–valsartan have recently shown convincing reductions in the combined risk of CVD and HF hospitalizations in patients with HF and mildly reduced ejection fraction (HFmrEF) or HFpEF. We aimed to investigate the cost-per-outcome implications of dapagliflozin vs sacubitril–valsartan in the treatment of HFmrEF or HFpEF patients.Methods:We compared the annualized cost needed to treat (CNT) to prevent the composite outcome of total HF hospitalizations and CVD with dapagliflozin or sacubitril–valsartan. The CNT was estimated by multiplying the annualized number needed to treat (aNNT) by the annual cost of therapy. The aNNT was calculated based on data collected from the DELIVER trial for dapagliflozin and a pooled analysis of the PARAGLIDE-HF and PARAGON-HF trials for sacubitril–valsartan. Costs were based on 2022 US prices. Scenario analyses were performed to attenuate the differences in the studies’ populations.Results:The aNNT with dapagliflozin in DELIVER was 30 (95% confidence interval [CI]: 21-62) versus 44 (95% CI: 25-311) with sacubitril–valsartan in a pooled analysis of PARAGLIDE-HF and PARAGON-HF, with an annual cost of $4,951 and $5,576, respectively. The corresponding CNTs were $148,547.13 (95% CI: $103,982.99–$306,997.39) for dapagliflozin and $245,346.77 (95% CI: $139,401.58–1,734,155.60) for sacubitril–valsartan for preventing the composite outcome of CVD and HF hospitalizations. The CNT for preventing all-cause mortality was lower for dapagliflozin than sacubitril–valsartan $1,128,958.15 [CI: $401,077.24–∞] vs $2,185,816.71 [CI: $607,790.87–∞].Conclusion:Dapagliflozin provides a better monetary value than sacubitril–valsartan in preventing the composite outcome of total HF hospitalizations and CVD among patients with HFmrEF or HFpEF.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Dapagliflozin versus sacubitril–valsartan for heart failure with mildly reduced or preserved ejection fraction

Arbel,

Azab,

Oberoi

et al. 2024

Front. Pharmacol.

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“…Another SGLT2 inhibitor, dapagliflozin, also showed a good cost‐effectiveness compared with SoC alone in patients with HFpEF in perspectives from a Chinese public healthcare 36 and public payers in European countries. 37 They assessed the cost‐effectiveness of dapagliflozin added to SoC compared with SoC alone based on the Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial, which was a placebo‐controlled trial in chronic HF patients with left ventricular ejection fraction > 40% that demonstrated a significant improvement in the combined incidence of HHF and CV death in patients treated with dapagliflozin added to SoC.…”

Section: Discussionmentioning

confidence: 99%

Empagliflozin cost‐effectiveness analysis in Japanese heart failure with mildly reduced and preserved ejection fraction

Tsutsui,

Sakamaki,

Momomura

et al. 2023

ESC Heart Failure

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AimsEmpagliflozin, a sodium‐glucose co‐transporter 2 inhibitor, was shown to be effective in patients with heart failure with preserved ejection fraction (HFpEF) in the EMPEROR‐Preserved trial. The present study aims to evaluate the cost‐effectiveness of empagliflozin among Japanese patients with HFpEF.Methods and resultsA Markov cohort model was developed to evaluate the cost‐effectiveness of empagliflozin added to standard of care (SoC) compared with SoC alone in patients with HFpEF from the perspective of the Japanese healthcare system and with a lifetime horizon. In addition to clinical events, the progression of disease severity was modelled based on the migration of Kansas City Cardiomyopathy Questionnaire‐Clinical Summary Scores (KCCQ‐CSS). Model inputs, including risk of clinical events, costs, and utilities/disutilities, were derived from EMPEROR‐Preserved trial data, a claims database and published literature. The generalizability of model results was investigated by applying various subgroups including age, body mass index (BMI), and region Asia, based on the subgroup analysis of EMPEROR‐Preserved data. In the base‐case analysis, empagliflozin yielded additional quality‐adjusted life years (QALYs; 0.11) with an incremental cost of $1408 per patient for Japanese patients with HFpEF. Incremental cost, mainly derived from drug acquisition cost ($1963 per patient), was largely offset by reduced cost in hospitalization for heart failure (HHF) and cardiovascular death (−$537 per patient and −$166 per patient, respectively). Treatment of empagliflozin provided incremental 0.11 QALYs and 0.08 life years compared with SoC alone. The incremental cost‐effectiveness ratio (ICER) was $12 772 (¥1 662 689)/QALY, which was below the Japanese willingness‐to‐pay (WTP) threshold of $38 408 (¥5 000 000)/QALY. The results were consistent across all the subgroups considered, and empagliflozin was dominant over SoC alone in the region Asia and BMI < 25 kg/m2 subgroups. ICERs for the remaining subgroups ranged from $7520/QALY (¥978 972/QALY, patients with baseline age ≥ 75 years) to $31 049/QALY (¥4 041 896/QALY, patients with baseline New York Heart Association class III/IV). Deterministic sensitivity analysis result showed that the treatment effect on HHF is the biggest driver of the cost‐effectiveness analysis, while the ICER will be still under the threshold even if no effect of empagliflozin on HHF was assumed. The probabilistic sensitivity analysis result showed that 64% of simulations were cost‐effective based on the Japanese WTP threshold.ConclusionsEmpagliflozin was demonstrated to be cost‐effective for patients with HFpEF in Japan based on EMPEROR‐Preserved trial data.

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“…On the other hand, several studies have demonstrated the cost-effectiveness of dapagliflozin in the whole spectrum of HF patients, regardless of the healthcare system of different countries [122][123][124][125][126][127][128]. In fact, the immediate initiation of dapagliflozin provides greater clinical benefits [128].…”

Section: Discussionmentioning

confidence: 99%

Current Role of SLGT2 Inhibitors in the Management of the Whole Spectrum of Heart Failure: Focus on Dapagliflozin

Escobar,

Pascual-Figal,

Manzano

et al. 2023

JCM

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Heart failure (HF) is associated with a high morbidity and mortality burden. In light of more recent evidence, SGLT2 inhibitors are currently recommended as first-line therapy in managing patients with HF, regardless of ejection fraction, to reduce HF burden. The DAPA-HF and DELIVER trials, and particularly, the pooled analysis of both studies, have shown that dapagliflozin significantly reduces the risk of cardiovascular death, all-cause death, total HF hospitalizations, and MACE in the whole spectrum of HF, with sustained benefits over time. Recent data have shown that the full implementation of dapagliflozin in clinical practice would translate into a robust reduction in hospitalizations for HF and death in real-life populations. Many pathophysiological mechanisms have been involved in these benefits, particularly the positive effects of dapagliflozin on reversing cardiac (atrial and ventricular) remodeling, reducing cardiac fibrosis and inflammation, and improving endothelial dysfunction. In this manuscript, we reviewed from a practical point of view the role of dapagliflozin in the management of the whole spectrum of patients with HF.

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Cost‐utility analysis of add‐on dapagliflozin in heart failure with preserved or mildly reduced ejection fraction

Cited by 9 publications

References 41 publications

Dapagliflozin versus sacubitril–valsartan for heart failure with mildly reduced or preserved ejection fraction

Dapagliflozin versus sacubitril–valsartan for heart failure with mildly reduced or preserved ejection fraction

Empagliflozin cost‐effectiveness analysis in Japanese heart failure with mildly reduced and preserved ejection fraction

Current Role of SLGT2 Inhibitors in the Management of the Whole Spectrum of Heart Failure: Focus on Dapagliflozin

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