Cost effectiveness of dapagliflozin for heart failure across the spectrum of ejection fraction: an economic evaluation based on pooled, individual participant data from the DELIVER and DAPA-HF trials

Bhatt, A. S. et al. (2024) Cost effectiveness of dapagliflozin for heart failure across the spectrum of ejection fraction: an economic evaluation based on pooled, individual participant data from the DELIVER and DAPA-HF trials. Journal of the American Heart Association, (doi: 10.1161/JAHA.123.032279) (PMID:38390793) (Early Online Publication)

Abstract

Background The sodium glucose cotransporter‐2 inhibitors are guideline‐recommended to treat heart failure across the spectrum of left ventricular ejection fraction; however, economic evaluations of adding sodium glucose cotransporter‐2 inhibitors to standard of care in chronic heart failure across a broad left ventricular ejection fraction range are lacking. Methods and Results We conducted a US‐based cost‐effectiveness analysis of dapagliflozin added to standard of care in a chronic heart failure population using pooled, participant data from the DAPA‐HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) and DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trials. The 3‐state Markov model used estimates of transitional probabilities, effectiveness of dapagliflozin, and utilities from the pooled trials. Costs estimates were obtained from published sources, including published rebates in dapagliflozin cost. Adding dapagliflozin to standard of care was estimated to produce an additional 0.53 quality‐adjusted life years (QALYs) compared with standard of care alone. Incremental cost effectiveness ratios were $85 554/QALY when using the publicly reported full (undiscounted) Medicare cost ($515/month) and $40 081/QALY, at a published nearly 50% rebate ($263/month). The addition of dapagliflozin to standard of care would be of at least intermediate value (<$150 000/QALY) at a cost of <$872.58/month, of high value (<$50 000/QALY) at <$317.66/month, and cost saving at <$40.25/month. Dapagliflozin was of at least intermediate value in 92% of simulations when using the full (undiscounted) Medicare list cost in probabilistic sensitivity analyses. Cost effectiveness was most sensitive to the dapagliflozin cost and the effect on cardiovascular death. Conclusions The addition of dapagliflozin to standard of care in patients with heart failure across the spectrum of ejection fraction was at least of intermediate value at the undiscounted Medicare cost and may be potentially of higher value on the basis of the level of discount, rebates, and price negotiations offered.

• Item Type: Articles
• Additional Information: This study was supported by a grant from AstraZeneca to Brigham and Women’s Hospital (Boston, MA).
• Keywords: cost-effectiveness, heart failure, SGLT2 inhibitors, value.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep and McMurray, Professor John
• Authors: Bhatt, A. S., Vaduganathan, M., Claggett, B. L., Kulac, I. J., Anand, I. S., Desai, A. S., Fang, J. C., Hernandez, A. F., Jhund, P. S., Kosiborod, M. N., Sabatine, M. S., Shah, S. J., Vardeny, O., McMurray, J. J. V., Solomon, S. D., and Gaziano, T. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of the American Heart Association
• Publisher: Wiley for the American Heart Association
• ISSN: 2047-9980
• ISSN (Online): 2047-9980
• Published Online: 23 February 2024
• Copyright Holders: Copyright: © 2024 The Authors
• First Published: First published in Journal of the American Heart Association 2024
• Publisher Policy: Reproduced under a Creative Commons licence