Cost-Effectiveness of Dapagliflozin vs Empagliflozin for Treating Heart Failure With Reduced Ejection Fraction in the United States.

Autor: Nechi RN; Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania., Rane A; Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts., Karaye RM; Aminu Kano Teaching Hospital, Kano, Nigeria., Ndikumukiza C; Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts., Alsahali S; Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia., Jatau AI; School of Pharmacy and Pharmacology, University of Tasmania, Australia., Zoni CR; UConn Health, Farmington, Connecticut., Alanzi A; Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf Province, Saudi Arabia., Karaye IM; Hofstra University, Hempstead, New York., Yunusa I; Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina; Center for Outcomes Research and Evaluation, University of South Carolina College of Pharmacy, Columbia, South Carolina. Electronic address: iyunusa@mailbox.sc.edu.
Jazyk: angličtina
Zdroj: Clinical therapeutics [Clin Ther] 2023 Jul; Vol. 45 (7), pp. 627-632. Date of Electronic Publication: 2023 Jun 01.
DOI: 10.1016/j.clinthera.2023.05.002
Abstrakt: Purpose: Evidence suggests that adding dapagliflozin to the prior standard of care is cost-effective compared with the standard of care alone. The latest guideline by the American Heart Association/American College of Cardiology/Heart Failure Society of America now recommends the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with heart failure with reduced ejection fraction (HFrEF). However, the relative cost-effectiveness of different SGLT2 inhibitors, including dapagliflozin and empagliflozin, has not been fully characterized. Therefore, we conducted a cost-effectiveness analysis to compare dapagliflozin and empagliflozin in patients with HFrEF from the US health care perspective.
Methods: To compare the cost-effectiveness of dapagliflozin and empagliflozin in treating HFrEF, we used a state-transition Markov model. This model was used to estimate the expected lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) for both medications. The model incorporated patients who were 65 years of age at entry and simulated their health outcomes over a lifetime horizon. The perspective of the analysis was based on the US health care system. To determine the health state transition probabilities, we used a network meta-analysis. All future costs and QALYs were discounted at an annual rate of 3%, and the costs were presented in 2022 US dollars.
Findings: The base case analysis found that the incremental expected lifetime cost of treating patients with dapagliflozin vs empagliflozin was $37,684, resulting in an ICER of $44,763 per QALY. A price threshold analysis indicated that for empagliflozin to be the most cost-effective SGLT2 inhibitor at a willingness-to-pay threshold of $50,000 per QALY, it may require a 12% discount on its current annual prices.
Implications: The findings of this study indicate that dapagliflozin may offer greater lifetime economic value when compared with empagliflozin. Given that the current clinical practice guideline does not recommend one SGLT2 inhibitor over the other, it is essential to implement scalable strategies to ensure affordable access to both medications. By doing so, patients and health care practitioners can make informed decisions about their treatment options without being constrained by financial barriers.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: