Objective: To evaluate the economics and effectiveness of adding dapagliflozin or empagliflozin to the standard treatment for heart failure (HF) for patients with reduced ejection fraction (HFrEF) in China.Methods: A Markov model was developed to project the clinical and economic outcomes of adding dapagliflozin or empagliflozin to the standard treatment for 66-year-old patients with HFrEF. A cost-utility analysis was performed based mostly on data from the empagliflozin outcome trial in patients with chronic heart failure and a reduced ejection fraction (EMPEROR-Reduced) study and the dapagliflozin and prevention of adverse outcomes in heart failure (DAPA-HF) trial. The primary outcomes were measured via total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER).Results: In China, compared to the standard treatment, although adding dapagliflozin to the standard treatment in the treatment of HFrEF was more expensive ($4,870.68 vs. $3,596.25), it was more cost-effective (3.87 QALYs vs. 3.64 QALYs), resulting in an ICER of $5,541.00 per QALY. Similarly, adding empagliflozin was more expensive ($5,021.93 vs. $4,118.86) but more cost-effective (3.66 QALYs vs. 3.53 QALYs), resulting in an ICER of $6,946.69 per QALY. A sensitivity analysis demonstrated the robustness of the model in identifying cardiovascular death as a significant driver of cost-effectiveness. A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per QALY, the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively. A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on ICER.Conclusion: Compared with standard treatments with or without empagliflozin, adding dapagliflozin to the standard treatment in the treatment of HFrEF in China was extremely cost-effective.

BackgroundThe Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved) is the first randomized controlled trial to provide promising evidence on the efficacy of adding empagliflozin to the standard therapy in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), but the cost-effectiveness of add-on empagliflozin treatment remains unclear.MethodA Markov model using data from the EMPEROR-Preserved trial and national database was constructed to assess lifetime costs and utility from a China healthcare system perspective. The time horizon was 10 years and a 5% discount rate was applied. Incremental cost-effectiveness ratio (ICER) against willingness to pay (WTP) threshold was performed to evaluate the cost-effectiveness. A series of sensitivity analyses was applied to ensure the robustness of the results.ResultsCompared to standard therapy, the increased cost of adding empagliflozin from $4,645.23 to $5,916.50 was associated with a quality-adjusted life years (QALYs) gain from 4.70 to 4.81, projecting an ICER of $11,292.06, which was lower than a WTP threshold of $12,652.5. Univariate sensitivity analysis revealed that the parameters with the largest impact on ICER were cardiovascular mortality in both groups, followed by the cost of empagliflozin and the cost of hospitalization for heart failure. Probabilistic sensitivity analysis indicated that when the WTP threshold was $12,652.5 and $37,957.5, the probability of being cost-effective for adding empagliflozin was 52.7% and 67.6%, respectively. Scenario analysis demonstrated that the cost of empagliflozin, the cost of hospitalization for heart failure, NYHA functional classes, and time horizon had a greater impact on the ICER.ConclusionAt a WTP threshold of $12,652.5, the add-on empagliflozin treatment for HFpEF was cost-effective in healthcare systems in China, which promoted the rational use of empagliflozin for HFpEF.

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Objective: To explore the prognosis of stent implantation on variant angina (VA) with severe organic stenosis. Background: Vasospasm is the pathogenesis of VA. Most VA patients are effective on calcium channel blockers (CCB) or nitrates, and the prognosis is generally good, but organic stenosis is a risk factor for VA. Method: We collected 141 VA patients treated with CCB and (or) nitrates in the First Affiliated Hospital of Zhengzhou University from December 2010 to June 2019. VA patients with diameter stenosis ≥50% were enrolled .They were divided into two groups according to the presence of stent implantation. The main adverse cardiovascular events (MACE) were observed including cardiogenic death, non-fatal myocardial infarction, readmission due to angina attack, coronary revascularization and heart failure. Results: 69 cases were included: 33 cases received stent implantation and 36 cases received medical treatment. The proportion of left anterior descending (LAD)(48% vs 44%,p=0.737 )which was the culprit coronary artery was very high. Diameter stenosis (84.3%±6.5 %VS 59.9%±010.1%，P<0.001)in stenting group was higher than that in stent-free group. Following up for 24 ± 23 months, there was no significant difference in the incidence of MACE (9% VS 11%) including cardiac death (3% VS 2.8%), coronary revascularization (0% VS 3%) and readmission due to angina (6% VS 5.6%), and effectiveness (88% VS 89%) between the two groups. CONCLUSION: Although the two groups showed similar clinical outcomes, with anti-spastic and antiplatelet medication, stent implantation was of benefit to the prognosis of VA with severe organic stenosis.