School of Public Health and Preventive Medicine, Monash University, Australia.
Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, Australia.
Eur J Prev Cardiol. 2021 Aug 9;28(9):975-982. doi: 10.1177/2047487320938272. Epub 2020 Jul 14.
To assess the cost-effectiveness of dapagliflozin in addition to standard care versus standard care alone in patients with chronic heart failure and reduced ejection fraction.
A Markov model was constructed based on the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial to assess the clinical outcomes and costs of 1000 hypothetical subjects with established heart failure and reduced ejection fraction. The model consisted of three health states: 'alive and event-free', 'alive after non-fatal hospitalisation for heart failure' and 'dead'. Costs and utilities were estimated from published sources. The main outcome was the incremental cost-effectiveness ratio per quality-adjusted life-year gained. An Australian public healthcare perspective was employed. All outcomes and costs were discounted at a rate of 5% annually.
Over a lifetime horizon, the addition of dapagliflozin to standard care in patients with heart failure and reduced ejection fraction prevented 88 acute heart failure hospitalisations (including readmissions) and yielded an additional 416 years of life and 288 quality-adjusted life-years (discounted) at an additional cost of A$3,692,440 (discounted). This equated to an incremental cost-effectiveness ratio of A$12,482 per quality-adjusted life-year gained, well below the Australian willingness-to-pay threshold of A$50,000 per quality-adjusted life-year gained. Subanalyses in subjects with and without diabetes resulted in similar incremental cost-effectiveness ratios of A$13,234 and A$12,386 per quality-adjusted life-year gained, respectively.
Dapagliflozin is likely to be cost-effective when used as an adjunct therapy to standard care compared with standard care alone for the treatment of chronic heart failure and reduced ejection fraction.
评估达格列净联合标准治疗相较于单独标准治疗在射血分数降低的慢性心力衰竭患者中的成本效果。
基于达格列净预防心力衰竭恶化的临床试验，建立马尔可夫模型，以评估 1000 名确诊心力衰竭和射血分数降低患者的临床结局和成本。该模型由三个健康状态组成：“无事件生存”“因心力衰竭非致死性住院后存活”和“死亡”。成本和效用值来自已发表的研究。主要结局为每获得一个质量调整生命年的增量成本效果比。采用澳大利亚公共医疗保健视角。所有结局和成本均以每年 5%的贴现率进行贴现。
在终生时间范围内，达格列净联合标准治疗可预防心力衰竭和射血分数降低患者 88 次急性心力衰竭住院（包括再入院），并额外获得 416 年的生命和 288 个质量调整生命年（贴现），额外成本为 3692440 澳元（贴现）。这相当于每获得一个质量调整生命年的增量成本效果比为 12482 澳元，远低于澳大利亚每获得一个质量调整生命年 50000 澳元的意愿支付阈值。在有和无糖尿病的患者亚组分析中，增量成本效果比分别为 13234 澳元和 12386 澳元每获得一个质量调整生命年。
与单独标准治疗相比，达格列净联合标准治疗用于治疗慢性心力衰竭和射血分数降低可能具有成本效果。
