The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health‐economic analysis of the DELIVER trial

Abstract

AimsTo determine the cost‐effectiveness of dapagliflozin, added to usual care, in patients with heart failure (HF) with mildly reduced or preserved ejection fraction for the UK, German and Spanish payers using detailed patient‐level data from the Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial.Methods and resultsA lifetime Markov state‐transition cohort model was developed. Quartiles of the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ‐TSS) defined health states and monthly transition count data informed transition probabilities. Multivariable generalized estimating equations captured the incidence of HF hospitalizations and urgent HF visits, while cardiovascular deaths and all‐cause mortality were estimated using adjusted parametric survival models. Health state costs were assigned to KCCQ‐TSS quartiles (2021 British pound [GBP]/Euro) and patient‐reported outcomes were sourced from DELIVER. Future values of costs and effects were discounted according to country‐specific rates. In the UK, dapagliflozin treatment was predicted to increase quality‐adjusted life years (QALYs) and life‐years by 0.231 and 0.354, respectively, and extend the time spent in the best quartile of KCCQ‐TSS by 4.2 months. Comparable outcomes were projected for Germany and Spain. The incremental cost‐effectiveness ratios were £7761, €9540 and €5343/QALY in the UK, Germany and Spain, respectively. According to regional willingness‐to‐pay thresholds, 91%, 89% and 92% of simulations in the UK, Germany and Spain, respectively, were cost‐effective following probabilistic sensitivity analyses.ConclusionDapagliflozin, added to usual care, is very likely cost‐effective for HF with mildly reduced or preserved ejection fraction in several European countries.

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

“…Relevant health state costs (inflated to 2022 Pounds Sterling) were assigned to the modelled KCCQ-TSS quartile health states in order to reflect the burden of HF. 20 Across a monthly cycle, the proportion of patients in each health state informed the relevant resource use and included the cost of primary care and cardiologist visits. Resource use was informed by a previous cost-effectiveness analysis, and corresponding costs inflated to net present 2022 values.…”

“…Resource use was informed by a previous cost-effectiveness analysis, and corresponding costs inflated to net present 2022 values. 20 Upon incidence of a transient event or an AE, a one-off event cost was applied in the model. Patients in receipt of dapagliflozin treatment were subject to treatment-related costs, in addition to the cost of usual care.…”

“…The health state utilities and utility decrements applied in the model are reported in Table 2. [20][21][22][23][24][25]…”

August 2023 at a glance: Focus on epidemiology and medical therapy

“…Sodium-glucose cotransporter 2 (SGLT2) inhibitors are mandatory in the treatment of HF, 3,[27][28][29] and their administration is also cost-effective, as more recently shown. 30 A secondary analysis of EMPEROR-Preserved assessed the effects of empagliflozin across the spectrum of kidney function. Overall, 5988 patients were included and categorized according to concomitant chronic kidney disease (CKD) at baseline (n = 3198, 53.5% with CKD).…”

“…Sodium–glucose cotransporter 2 (SGLT2) inhibitors are mandatory in the treatment of HF, 3,27–29 and their administration is also cost‐effective, as more recently shown 30 …”