Miller, R. J.H., Chew, D. S., Qin, L., Fine, N. M., Chen, J., McMurray, J. J.V. , Howlett, J. G. and McEwan, P. (2023) Cost‐effectiveness of immediate initiation of dapagliflozin in patients with a history of heart failure. European Journal of Heart Failure, 25(2), pp. 238-247. (doi: 10.1002/ejhf.2777) (PMID:36644849)
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Abstract
Aims: To compare the cost-effectiveness of immediate and 12 months delayed initiation of dapagliflozin treatment in patients with a history of hospitalization for heart failure (HHF) from the UK, Canadian, German, and Spanish healthcare perspectives. Methods and results: A cost-utility analysis was conducted using a decision-analytic Markov model with health states defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores (shown in the graphical abstract), type 2 diabetes mellitus status (T2DM) and incidence of heart failure (HF) events. Patient-level data for patients with prior HHF from the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial was used to inform the model inputs on clinical events and utility values. Healthcare costs were sourced from the relevant national reference databases and the published literature. Compared to standard therapy, immediate initiation of dapagliflozin decreased HHF (187 events), urgent HF visits (32 events) and cardiovascular mortality (18 events). Standard therapy was associated with lifetime costs of £13,224 and 4.02 QALYs. Twelve months delayed initiation of dapagliflozin was associated with total discounted lifetime costs and QALYs of £16,660 and 4.61 respectively compared to £16,912 and 4.66 respectively for immediate initiation. Compared to standard therapy, immediate and 12 months delayed initiation of dapagliflozin yielded incremental cost-effectiveness ratio (ICER) £5,779 and £5,821, respectively. Compared to 12 months delayed initiation, immediate initiation of dapagliflozin had an ICER of £5,263. Results were similar from the Canadian, German, and Spanish healthcare perspectives. Conclusion: Both immediate and 12 months delayed initiation of dapagliflozin are cost-effective. However, immediate initiation provides greater clinical benefits, with almost 10% additional QALYs gain, compared 12 months delayed initiation of dapagliflozin and should be considered standard of care.
| Item Type: | Articles |
|---|---|
| Additional Information: | This work was supported by AstraZeneca who provided support for the analysis for this study. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
| Authors: | Miller, R. J.H., Chew, D. S., Qin, L., Fine, N. M., Chen, J., McMurray, J. J.V., Howlett, J. G., and McEwan, P. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | European Journal of Heart Failure |
| Publisher: | Wiley |
| ISSN: | 1388-9842 |
| ISSN (Online): | 1879-0844 |
| Published Online: | 16 January 2023 |
| Copyright Holders: | Copyright © 2023 Health Economics and Outcomes Research, AstraZeneca and The Authors |
| First Published: | First published in European Journal of Heart Failure 25(2): 238-247 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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