Prescribing patterns of SGLT-2 inhibitors for patients with heart failure: A two-center analysis

Chakrala, Teja S.; Prakash, Roshni; Kim, Justin; Gao, Hanzhi; Ghaffar, Umar; Patel, Jaymin; Parker, A. H.; Dass, Bhagwan

doi:10.1016/j.ahjo.2023.100286

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…This finding is further confirmed by the fact that the life years and QALYs gained in the NYHA model were primarily contributed by patients in NYHA class II. Despite clinical trials demonstrating the efficacies of SGLT2i in improving clinical outcomes in HFrEF patients (McMurray et al, 2019;Packer et al, 2020) and international guidelines advocating SGLT2i as part of guideline-directed medical therapy (GDMT) for HFrEF patients (McDonagh et al, 2021;Heidenreich et al, 2022), the SGLT2i prescribing rates reported in multiple observational studies are still low (Canonico et al, 2022;Chakrala et al, 2023;Okoroike et al, 2023). One potential barrier that prevents prescribing GDMT, including SGLT2i, is the medication acquisition costs (Canonico et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of adding empagliflozin to the standard of care for patients with heart failure with reduced ejection fraction from the perspective of healthcare system in Malaysia

2023

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Objective: The aim of this study was to determine the cost-effectiveness of adding empagliflozin to the standard of care versus SoC alone for the treatment of patients with heart failure (HF) with reduced ejection fraction (HFrEF) from the perspective of the Ministry of Health of Malaysia.Methods: A cohort-based transition-state model, with health states defined as Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) quartiles and death, was used to determine the lifetime direct medical costs and quality-adjusted life years (QALYs) for both treatment groups. The risks of all-cause death, cardiovascular death, and health state utilities were estimated from the EMPEROR-Reduced trial. The incremental cost-effectiveness ratio (ICER) was assessed against the cost-effectiveness threshold (CET) as defined by the country’s gross domestic product per capita (RM 47,439 per QALY) to determine cost-effectiveness. Sensitivity analyses were conducted to assess the key model parameters’ uncertainty in respect to the incremental cost-effectiveness ratio. A scenario analysis was performed using health states as defined by the New York Heart Association classes.Results: Compared to SoC alone, empagliflozin + SoC for the treatment of HFrEF was more expensive (RM 25,333 vs. RM 21,675) but gained more health utilities (3.64 vs. 3.46), resulting in an ICER of RM 20,400 per QALY in the KCCQ-CSS model. A NYHA-based scenario analysis generated an ICER of RM 36,682 per QALY. A deterministic sensitivity analysis confirmed the robustness of the model in identifying the empagliflozin cost as the main driver of cost-effectiveness. The ICER was reduced to RM 6,621 when the government medication purchasing prices were used. A probabilistic sensitivity analysis with a CET of 1xGDP per capita reached 72.9% probability for empagliflozin + SoC against SoC being cost-effective.Conclusion: Empagliflozin + SoC compared to SoC alone for the treatment of HFrEF patients was cost-effective from the perspective of the MoH of Malaysia.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of adding empagliflozin to the standard of care for patients with heart failure with reduced ejection fraction from the perspective of healthcare system in Malaysia

2023

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“…O SGLT2 (do inglês Sodium-Glucose Cotransporters 2) é a proteína de membrana majoritariamente utilizada na absorção e na reabsorção renal de glicose. Dessa forma, a terapia com inibidores do SGLT2 (iSGLT2), as gliflozinas, é uma das opções candidatas a sistemática prescrição médica na atualidade (CHAKRALA T, et al Entretanto, muito ainda deve ser feito para que haja a adoção sistemática dos iSGLT2 como opção terapêutica para pacientes com esse quadro clínico, dado que sua prescrição perante outros fármacos tradicionais ainda é irrisória (CHAKRALA T, et al, 2023).…”

Section: Introductionunclassified

Uso de inibidores de SGLT2 no tratamento da insuficiência cardíaca compensada em pacientes diabéticos

Cruz Neto,

Macêdo,

Silva

et al. 2024

Acervo Saúde

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Objetivo: Entender os benefícios do uso de inibidores da SGLT2 para ICFEp em pacientes diabéticos. Métodos: A presente revisão integrativa da literatura buscou responder o seguinte problema: “Quais as vantagens do uso de inibidores de SGLT2 para ICFEp em pacientes diabéticos?”. Foi realizada busca nas plataformas PubMed, VHS e BVS, através dos descritores em inglês “Gliflozins”, “Heart failure with preserved ejection fraction”, “treatment” e “Diabetes Mellitus”, retirados dos Descritores em Ciências da Saúde (DeCS) e interpostos pelo operador booleano “AND”. Estudos entre 2013-2023, em inglês e/ou português, completos e gratuitos foram incluídos, e aqueles que fugiram do tema central, desconsiderados. Resultados: 16 estudos foram aprovados, com diversidade de ensaios clínicos e revisões da literatura. A hospitalização de pacientes com DM2 e ICFEp foi consideravelmente reduzida com gliflozinas, dados seus mecanismos cardioprotetores, havendo menores efeitos colaterais. Maiores destaques foram atribuídos para a empagliflozina, dapagliflozina e canagliflozina. Outros iSGLT2 necessitam de maior aprofundamento. Considerações finais: Inibidores de SGLT2, como empagliflozina e dapagliflozina reduzem complicações da ICFEp e hospitalizações em diabéticos. Sugere-se avaliação governamental e pesquisas para seu uso em pré-diabéticos e normoglicêmicos. Gliflozinas trazem benefícios principalmente em terapia combinada e estilo de vida. Assim, há tendência de aumento de seu uso no futuro.

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Sodium–glucose cotransporter 2 inhibitors reduce the risk of incident type 2 diabetes in people with heart failure without diabetes: An analysis of real‐world, cohort data

Henney,

Riley,

Heague

et al. 2024

Diabetes Obesity Metabolism

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AimSodium–glucose cotransporter 2 inhibitors (SGLT2is), used as a glucose‐lowering therapy in people with type 2 diabetes (T2D), have significant cardiorenal benefits, reducing hospitalization for heart failure (HF) and cardiovascular mortality in patients with and without T2D. Recent clinical trial evidence suggests their potential utility in preventing incident T2D among the high‐risk HF populations. Therefore, we aimed to assess whether this finding was reproducible in a real‐world setting.MethodsWe performed a retrospective cohort analysis of 484 643 patients with HF, without baseline diabetes, prescribed either angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers with/without SGLT2is (treatment, n = 42 018; reference, n = 442 625) across 95 global health care organizations, using a large real‐world ecosystem. Propensity score matching balanced arms 1:1 for confounders (n = 39 168 each arm). Subgroup analysis further evaluated the impact on patients with prediabetes and the efficacy of dapagliflozin/empagliflozin, specifically, on incident T2D and secondary outcomes, including all‐cause mortality, acute pulmonary oedema and hospitalization.ResultsTreatment with SGLT2is significantly reduced incident T2D {hazard ratio (HR) 0.71 [95% confidence interval (CI) 0.63, 0.75]} in patients with HF. The analysis of patients with prediabetes found that SGLT2is further reduced incident T2D [HR 0.62 (95% CI 0.45, 0.80)]. The magnitude of reduction in incident T2D was higher in patients prescribed dapagliflozin [HR 0.47 (95% CI 0.39, 0.56)] versus empagliflozin [HR 0.81 (95% CI 0.70, 0.93)].ConclusionTreatment with SGLT2is in patients with HF was associated with a reduced risk of incident T2D, most strikingly in people with prediabetes.

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Prescribing patterns of SGLT-2 inhibitors for patients with heart failure: A two-center analysis

Cited by 5 publications

References 31 publications

Cost-effectiveness of adding empagliflozin to the standard of care for patients with heart failure with reduced ejection fraction from the perspective of healthcare system in Malaysia

Cost-effectiveness of adding empagliflozin to the standard of care for patients with heart failure with reduced ejection fraction from the perspective of healthcare system in Malaysia

Uso de inibidores de SGLT2 no tratamento da insuficiência cardíaca compensada em pacientes diabéticos

Sodium–glucose cotransporter 2 inhibitors reduce the risk of incident type 2 diabetes in people with heart failure without diabetes: An analysis of real‐world, cohort data

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