Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

Abstract

Aims This study was to determine the cost-effectiveness of dapagliflozin in heart failure with reduced ejection fraction (HFrEF) patients in China from a perspective of health care payers. Methods and results We built a Markov model to perform a cost-effectiveness analysis comparing standard treatment + dapagliflozin (10 mg, q.d.) with standard treatment for HFrEF. The base case in our simulation was a 65-yearold HFrEF patient and was modelled over 15 years. Inputs of the model were derived from the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial and other relevant data from China. Costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) were estimated for adding dapagliflozin relative to standard treatment. Costs and QALY were discounted at a 4.2% rate annually. All costs are presented in 2017 US dollars. Dapagliflozin would be considered very cost-effective if the ICER was lower than a willingness-to-pay (WTP) threshold of $8573.4. Uncertainty was assessed in our model using one-way, two-way, and probabilistic sensitivity analysis (PSA). In our base case, compared with standard treatment, adding dapagliflozin was more expensive ($5829.4 vs. $4377.1) but more effective (4.82 vs. 4.44 QALYs). The respondent ICER was $3827.6 per QALY gained at 15-year follow-up. When the simulated horizon was longer than 3.5 years, the respondent ICER became lower than the WTP threshold. The inputs with the largest impact on ICER were the cost of dapagliflozin, the cardiovascular mortality in both groups, and the cost of hospitalization for heart failure. Most results of sensitivity analysis were robust. PSA showed a similar result as the base case (ICER = $4412.5 per QALY gained). In Monte Carlo simulation, at a WTP threshold of $8573.4 per QALY, dapagliflozin was considered very cost-effective in 53.10% of the simulations. Conclusions Dapagliflozin was a very cost-effective treatment option for HFrEF patients in China according to the result of our model. Our findings will help doctors and health care payers to make decisions in clinical practice. Future real-world studies of cost-effectiveness of dapagliflozin based on Chinese population were also needed.

Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction

“…The annual cost of dapagliflozin is substantially higher in the US compared with other health systems ($4192 in our base case, compared with the equivalent of $302-$780 in Europe, $257 in China, and $563 in Australia per the published analyses). [37][38][39] Furthermore, we included all background health care costs (in line with current recommendations) whereas the European analysis only included costs related to diabetes and heart failure. 10 As a result, despite comparable health gains, the ICER was substantially Cost-effectiveness analysis provides a formal mechanism to quantify the gains or losses in population health as a result of a particular intervention.…”

Economic Evaluation of Dapagliflozin in the Treatment of Patients With Heart Failure: A Systematic Review

“…Eight articles were removed, primarily because they were commentaries (n = 2), no economic evaluation (n = 1), incomplete data (n = 2), not heart failure (n = 1), repeated publication (n = 1), and full text was not available (n = 1). Finally, eight articles were selected in this systematic review ( McEwan et al, 2020 ; Yao et al, 2020 ; Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Liao et al, 2021 ; Mendoza et al, 2021 ; Parizo et al, 2021 ; Savira et al, 2021 ). More details of the retrieval process are shown in Figure 1 .…”

“…The time horizon of most of the studies was a lifetime (n = 6) ( McEwan et al, 2020 ; Isaza et al, 2021 ; Krittayaphong and Permsuwan, 2021 ; Mendoza et al, 2021 ; Parizo et al, 2021 ; Savira et al, 2021 ), and the remaining two studies were 15 years ( Yao et al, 2020 ; Liao et al, 2021 ). Six studies used 1-year Markov cycles, and one study used 3-month Markov cycles, while one study however adopted 1-month Markov cycles.…”

SGLT-2 Inhibitors on Top of Current Pharmacological Treatments for Heart Failure: A Comparative Review on Outcomes and Cost Effectiveness

“…Variations in ICERs across different countries were primarily driven by drug acquisition costs. Similarly, the cost effectiveness of dapagliflozin was maintained in the Australian setting, with an ICER of $US9320 per QALY gained, nearly 74% lower than the commonly accepted Australian willingness-to-pay threshold of $US36,055 per QALY gained [44], and in China, with an ICER of $US3828 per QALY gained, largely lower than the willingness-to-pay threshold of $US8573 [45].…”