Cost-utility analysis of empagliflozin in heart failure patients with reduced and preserved ejection fraction in China

Abstract

Objective: EMPEROR-Reduced and EMPEROR-Preserved studies showed the benefits of empagliflozin along with a reduction in cardiovascular death or hospitalisation for heart failure (HF). Our aim was to evaluate the economics and effectiveness of adding empagliflozin to the standard therapy for HF with reduced ejection fraction (HFrEF) and HF preserved ejection fraction (HFpEF) in China.Methods: A multistate Markov model was constructed to yield the clinical and economic outcomes of adding empagliflozin to the standard therapy for 65-year-old patients with HFrEF and HFpEF. A cost-utility analysis was conducted, mostly derived from the EMPEROR-Reduced study, EMPEROR-Preserved study, and national statistical database. All costs and outcomes were discounted at the rate of 5% per annum. The primary outcomes were total and incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were also performed.Results: In the HFrEF population, the 10-year incremental cost was $827.52 and the 10-year incremental QALY was 0.15 QALYs, resulting in an ICER of $5,612.06/QALY, which was below the WTP of $12,652.5/QALY. In the HFpEF population, compared with the control group, the incremental cost was $1,271.27, and the incremental QALY was 0.11 QALYs, yielding an ICER of 11,312.65 $/QALY, which was also below the WTP of $12,652.5/QALY. In the HFrEF and HFpEF populations, the results of a one-way sensitivity analysis showed that the risk of cardiovascular death in both groups was the most influential parameter. In the HFrEF population, a probability sensitivity analysis (PSA) revealed that when the WTP thresholds were $12,652.5/QALY and $37,957.5/QALY, the probabilities of being cost-effective with empagliflozin as an add-on were 59.4% and 72.6%, respectively. In the HFpEF population, the PSA results revealed that the probabilities of being cost-effective with empagliflozin as an add-on were 53.1% and 72.2%, respectively.Conclusion: Considering that the WTP threshold was $12,652.5/QALY, adding empagliflozin to standard therapy was proven to be a slightly more cost-effective option for the treatment of HFrEF and HFpEF from a Chinese healthcare system perspective, which promoted the rational use of empagliflozin for HF.

Cost‐effectiveness of dapagliflozin for patients with heart failure across the spectrum of ejection fraction: A pooled analysis of DAPA‐HF and DELIVER data

“…dapagliflozin was more cost-effective) for patients with HF with lower stratifications of LVEF. This finding aligns with the outcomes presented by Tang et al 28 and Hallinen et al 29 in their investigations of empagliflozin across the spectrum of HF, although it is important to note that both studies used separate models for the HF with reduced and preserved ejection fraction populations and weighted averaging to generate a result for the overall HF population. In terms of clinical events, model predictions according to LVEF were also in line with clinical trial results, where event rates for recurrent HHF and CV death were observed to be higher for HF with reduced ejection fraction than for HF with preserved ejection fraction.…”

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

“…The cost per QALY gained was $11 809 in Thailand with a lower WTP ($4773.27/QALY), which empagliflozin was not a cost‐effective add‐on treatment for patients with HFpEF 38 . We previously reported the pharmacoeconomics advantage of empagliflozin in HFrEF and HFpEF in China 41 . Additionally, several studies have shown that dapagliflozin was cost‐effective in the treatment of diabetes 42,43 Therefore, adding dapagliflozin to standard therapy was a cost‐effective choice for HFpEF and HFmrEF patients with diabetes.…”

“…38 We previously reported the pharmacoeconomics advantage of empagliflozin in HFrEF and HFpEF in China. 41 Additionally, several studies have shown that dapagliflozin was cost-effective in the treatment of diabetes 42,43 Therefore, adding dapagliflozin to standard therapy was a cost-effective choice for HFpEF and HFmrEF patients with diabetes.…”

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

“…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 38 .…”

“…In the 2022 AHA/ACC/HFSA guidelines, a value statement is also described and the importance of analysis from the cost‐effectiveness perspective has been increasing globally 7 . There are prior studies that evaluated the cost‐effectiveness of SGLT2 inhibitors for patients with HFpEF 8–14 . However, in Japan, there is limited evidence of cost‐effectiveness for some types of HF medication (e.g.…”