Cost-Effectiveness of Adding Empagliflozin to Standard Treatment for Heart Failure with Preserved Ejection Fraction Patients in China

Lou, Yake; Hu, Tianyang; Huang, Jing

doi:10.1007/s40256-022-00550-9

Cited by 10 publications

(11 citation statements)

References 33 publications

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“…There are several reports to evaluate cost‐effectiveness of empagliflozin in patients with HFpEF in other countries, and most of them showed that empagliflozin was cost‐effective 9,10,13,34,35 . However, some reports are not consistent with our present results, which might be due to the model difference.…”

Section: Discussioncontrasting

confidence: 75%

“…In the 2022 AHA/ACC/HFSA guidelines, a value statement is also described and the importance of analysis from the cost‐effectiveness perspective has been increasing globally 7 . There are prior studies that evaluated the cost‐effectiveness of SGLT2 inhibitors for patients with HFpEF 8–14 . However, in Japan, there is limited evidence of cost‐effectiveness for some types of HF medication (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Empagliflozin cost‐effectiveness analysis in Japanese heart failure with mildly reduced and preserved ejection fraction

Tsutsui,

Sakamaki,

Momomura

et al. 2023

ESC Heart Failure

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AimsEmpagliflozin, a sodium‐glucose co‐transporter 2 inhibitor, was shown to be effective in patients with heart failure with preserved ejection fraction (HFpEF) in the EMPEROR‐Preserved trial. The present study aims to evaluate the cost‐effectiveness of empagliflozin among Japanese patients with HFpEF.Methods and resultsA Markov cohort model was developed to evaluate the cost‐effectiveness of empagliflozin added to standard of care (SoC) compared with SoC alone in patients with HFpEF from the perspective of the Japanese healthcare system and with a lifetime horizon. In addition to clinical events, the progression of disease severity was modelled based on the migration of Kansas City Cardiomyopathy Questionnaire‐Clinical Summary Scores (KCCQ‐CSS). Model inputs, including risk of clinical events, costs, and utilities/disutilities, were derived from EMPEROR‐Preserved trial data, a claims database and published literature. The generalizability of model results was investigated by applying various subgroups including age, body mass index (BMI), and region Asia, based on the subgroup analysis of EMPEROR‐Preserved data. In the base‐case analysis, empagliflozin yielded additional quality‐adjusted life years (QALYs; 0.11) with an incremental cost of $1408 per patient for Japanese patients with HFpEF. Incremental cost, mainly derived from drug acquisition cost ($1963 per patient), was largely offset by reduced cost in hospitalization for heart failure (HHF) and cardiovascular death (−$537 per patient and −$166 per patient, respectively). Treatment of empagliflozin provided incremental 0.11 QALYs and 0.08 life years compared with SoC alone. The incremental cost‐effectiveness ratio (ICER) was $12 772 (¥1 662 689)/QALY, which was below the Japanese willingness‐to‐pay (WTP) threshold of $38 408 (¥5 000 000)/QALY. The results were consistent across all the subgroups considered, and empagliflozin was dominant over SoC alone in the region Asia and BMI < 25 kg/m2 subgroups. ICERs for the remaining subgroups ranged from $7520/QALY (¥978 972/QALY, patients with baseline age ≥ 75 years) to $31 049/QALY (¥4 041 896/QALY, patients with baseline New York Heart Association class III/IV). Deterministic sensitivity analysis result showed that the treatment effect on HHF is the biggest driver of the cost‐effectiveness analysis, while the ICER will be still under the threshold even if no effect of empagliflozin on HHF was assumed. The probabilistic sensitivity analysis result showed that 64% of simulations were cost‐effective based on the Japanese WTP threshold.ConclusionsEmpagliflozin was demonstrated to be cost‐effective for patients with HFpEF in Japan based on EMPEROR‐Preserved trial data.

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Section: Discussioncontrasting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Empagliflozin cost‐effectiveness analysis in Japanese heart failure with mildly reduced and preserved ejection fraction

Tsutsui,

Sakamaki,

Momomura

et al. 2023

ESC Heart Failure

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“…Recent studies have assessed the cost-effectiveness of the SGLT2 inhibitor, empagliflozin, in various non-European countries in a similar patient population. [40][41][42] Unlike these prior studies that used aggregate data from trial publications, this present analysis was performed on individual patient-level data from the DELIVER trial. While both approaches are valid, the present analysis allows for the adjustment of patient characteristics to reproduce the trial-observed effects on mortality, events and HRQoL.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have assessed the cost‐effectiveness of the SGLT2 inhibitor, empagliflozin, in various non‐European countries in a similar patient population 40–42 . Unlike these prior studies that used aggregate data from trial publications, this present analysis was performed on individual patient‐level data from the DELIVER trial.…”

Section: Discussionmentioning

confidence: 99%

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

Davis

McEwan

et al. 2023

European J of Heart Fail

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AimsTo 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 resultsA 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 generalized estimating equations captured the incidence of HF hospitalizations 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 values 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 £7761, €9540 and €5343/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.ConclusionDapagliflozin, added to usual care, is very likely cost‐effective for HF with mildly reduced or preserved ejection fraction in several European countries.

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“…Another discussion could be conducted to resolve discrepancies. Lin et al, 2022;Lou et al, 2022;Tang and Sang, 2022;Zheng et al, 2022;Zhou et al, 2022) were included in this review, and more details about studies identified were reported in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

Cost-effectiveness of empagliflozin for the treatment of heart failure: a systematic review

Liu,

Gong

et al. 2023

Front. Pharmacol.

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Objective: This study aims to synthesize evidence on the cost-effectiveness of empagliflozin for heart failure (HF).Methods: MEDLINE, Embase, the Cochrane Library, EconLit, CNKI, Wanfang Data and Chongqing VIP were searched to identify original articles on cost-effectiveness of empagliflozin for HF, and literature surveillance ended on 20 November 2022. The reporting quality of the included articles was determined using the Consolidated Health Economic Evaluation Reporting Standards statement.Results: Of 97 articles identified, 11 studies published from 2020 to 2022 met the inclusion criteria, and the overall quality was accepted. The studies were conducted in 8 countries (China, Japan, Korea, Singapore, Thailand, Australia, United States, and United Kingdom). This body of evidence suggested that add-on empagliflozin was cost effective for HF with reduced ejection fraction (HFrEF) patients compared to standard of care alone in all the related studies including China, Japan, Korea, Singapore, Thailand, and Australia. For HF with preserved ejection fraction (HFpEF) patients, add-on empagliflozin was cost effective in China and Australia, but not in United States and Thailand. For HF with diabetes, add-on empagliflozin was cost effective in United Kingdom. Moreover, the incremental cost-effectiveness ratios (ICER) were lower for patients with diabetes than without in subgroup analysis. In the uncertainty analysis of all included studies, the ICERs were most sensitive to the cost of empagliflozin and cardiovascular mortality, followed by the cost of the standard treatment, hazard ratio of HF hospitalization.Conclusion: add-on empagliflozin for HFrEF might be cost-effective or dominant compared with standard of care alone. However, for HFpEF patients, add-on empagliflozin might be cost-effective in China and Australian, but not cost-effective in United States and Thailand.

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Cost-Effectiveness of Adding Empagliflozin to Standard Treatment for Heart Failure with Preserved Ejection Fraction Patients in China

Cited by 10 publications

References 33 publications

Empagliflozin cost‐effectiveness analysis in Japanese heart failure with mildly reduced and preserved ejection fraction

Empagliflozin cost‐effectiveness analysis in Japanese heart failure with mildly reduced and preserved ejection fraction

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

Cost-effectiveness of empagliflozin for the treatment of heart failure: a systematic review

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