Cost-effectiveness of dapagliflozin as a treatment for heart failure with reduced ejection fraction: a multinational health-economic analysis of DAPA-HF

McEwan, P., Darlington, O., McMurray, J. J.V. , Jhund, P. S. , Docherty, K. F. , Böhm, M., Petrie, M. C. , Bergenheim, K. and Qin, L. (2020) Cost-effectiveness of dapagliflozin as a treatment for heart failure with reduced ejection fraction: a multinational health-economic analysis of DAPA-HF. European Journal of Heart Failure, 22(11), pp. 2147-2156. (doi: 10.1002/ejhf.1978) (PMID:32749733) (PMCID:PMC7756637)

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Abstract

AIM:To estimate the cost-effectiveness of dapagliflozin added to standard therapy, versus standard therapy only, in patients with heart failure (HF) with reduced ejection fraction, from the perspective of UK, German, and Spanish payers. METHODS AND RESULTS:A lifetime Markov model was built to estimate outcomes in patients with HFrEF. Health states were defined by Kansas City Cardiomyopathy Total Symptom Score, type 2 diabetes and worsening HF events. The incidence of worsening HF and all-cause mortality was estimated using negative binomial regression models and parametric survival analysis, respectively. Direct healthcare costs (2019 British pounds/Euro) and patient-reported outcomes (EQ-5D) were sourced from the existing literature and the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF), respectively; the median duration of follow-up in DAPA-HF was 18.2 months (range: 0-27.8). Future costs and effects were discounted at 3.0% for the Spanish and German analyses and 3.5% for the UK analysis. In the UK setting, treatment with dapagliflozin was estimated to increase life-years and quality-adjusted life-years (QALYs) from 5.62 to 6.20 (+0.58) and 4.13 to 4.61 (+0.48), respectively, and reduce lifetime hospitalisations for HF (925 and 820 events per 1,000 patients for placebo and dapagliflozin, respectively). Similar results were obtained for Germany and Spain. The incremental cost-effectiveness ratios were £5,822, €5,379 and €9,406/QALY in the UK, Germany and Spain, respectively. In probabilistic sensitivity analyses, more than 90% of simulations were cost-effective at a willingness-to-pay threshold of £20,000/QALY in UK and €20,000/QALY in Germany and Spain. CONCLUSION:Dapagliflozin is likely to be a cost-effective treatment for HFrEF in the UK, German and Spanish healthcare systems. This article is protected by copyright. All rights reserved.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Docherty, Dr Kieran and Jhund, Dr Pardeep and Petrie, Professor Mark and McMurray, Professor John
Authors: McEwan, P., Darlington, O., McMurray, J. J.V., Jhund, P. S., Docherty, K. F., Böhm, M., Petrie, M. C., Bergenheim, K., and Qin, L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:04 August 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in European Journal of Heart Failure 22(11):2147-2156
Publisher Policy:Reproduced under a Creative Commons License

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