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

Booth, D., Davis, J. A., McEwan, P., Solomon, S. D., McMurray, J. J.V. , de Boer, R. A., Comin‐Colet, J., Bachus, E. and Chen, J. (2023) The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: a European health‐economic analysis of the DELIVER trial. European Journal of Heart Failure, (doi: 10.1002/ejhf.2940) (PMID:37344985) (Early Online Publication)

Abstract

Aims: 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 Results: A 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 generalised estimating equations captured the incidence of HF hospitalisations 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 value 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 £7,761, €9,540 and €5,343/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. Conclusion: Dapagliflozin, added to usual care, is very likely cost-effective for HF with mildly reduced or preserved ejection fraction in several European countries.

• Item Type: Articles
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Booth, D., Davis, J. A., McEwan, P., Solomon, S. D., McMurray, J. J.V., de Boer, R. A., Comin‐Colet, J., Bachus, E., and Chen, J.
• 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: 21 June 2023
• Copyright Holders: Copyright © 2023 Health Economics and Outcomes Research Ltd and The Authors
• First Published: First published in European Journal of Heart Failure 2023
• Publisher Policy: Reproduced under a Creative Commons License