Department of Physiology and Section of Cardiology, Department of Internal Medicine, De La Salle Medical and Health Sciences Institute, Dasmariñas, Cavite, Philippines.
Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, United Nations Avenue, Manila, 1000, Philippines.
ESC Heart Fail. 2021 Dec;8(6):5132-5141. doi: 10.1002/ehf2.13583. Epub 2021 Sep 7.
We aim to determine the cost-effectiveness of dapagliflozin in addition to standard therapy versus standard therapy alone among patients with heart failure with reduced ejection fraction (HFrEF) using the public healthcare provider's perspective in the Philippines.
A thousand Filipino patients with HFrEF (with or without type 2 diabetes mellitus) were included in a simulation cohort using a lifetime Markov model. The model, which was developed based on the results of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial, was composed of three health states. These were 'alive without an event' (chronic heart failure state), 'alive but was hospitalized for heart failure' (worsening heart failure), and 'dead' (death from any cause). Data regarding costs and utilities were obtained from previous studies and local data. These were used to estimate the incremental cost per quality-adjusted life-year (ICER). A 3% annual discount rate was used for both costs and effects. One-way (deterministic) and probabilistic sensitivity analyses as well as scenario analyses were performed. The ICER for the addition of dapagliflozin to standard therapy among HFrEF patients was PHP177 868 (US$3434) and PHP160 983 (US$3108), respectively, if the present price (PHP44.00) and possible negotiated unit cost of dapagliflozin 10 mg tablet (PHP40.00) were used. These were deemed cost-effective because they were both below the threshold ICER which was equivalent to the gross domestic product per capita of the Philippines in 2019, PHP180 500 (US$3485). Using the unit costs of dapagliflozin previously mentioned, the ICERs among HFrEF patients with diabetes were PHP132 582 (US$2560) and PHP120 249 (US$2321), respectively. Doing PSA involving Monte Carlo simulation of 10 000 iterations and plotting the resulting ICERs against the threshold ICER in the cost-effectiveness acceptability curves, these ICERs for HFrEF among diabetics were determined to be 72% and 76% cost-effective.
Dapagliflozin added to standard therapy for HFrEF patients is likely to be cost-effective using the perspective of the Philippine public healthcare provider.
我们旨在从菲律宾公共医疗保健提供者的角度出发，确定在射血分数降低的心力衰竭（HFrEF）患者中，与单独标准治疗相比，加用达格列净的成本效益。
使用基于 Dapagliflozin 和预防心力衰竭不良结局试验（DAPA-HF）结果的终生马尔可夫模型，纳入 1000 名菲律宾 HFrEF 患者（有或无 2 型糖尿病）进行模拟队列。该模型由三个健康状态组成：“无事件存活”（慢性心力衰竭状态）、“因心力衰竭住院但存活”（心力衰竭恶化）和“死亡”（任何原因死亡）。成本和效用数据来自先前的研究和当地数据。这些数据用于估计每质量调整生命年的增量成本（ICER）。对成本和效果均采用 3%的年度贴现率。进行了单因素（确定性）和概率敏感性分析以及情景分析。如果使用目前的价格（PHP44.00）和可能的达格列净 10mg 片剂谈判单位成本（PHP40.00），则在 HFrEF 患者中添加达格列净的 ICER 分别为 PHP177868（3434 美元）和 PHP160983（3108 美元）。这些被认为是具有成本效益的，因为它们都低于阈值 ICER，相当于 2019 年菲律宾的人均国内生产总值，即 PHP180500（3485 美元）。使用前面提到的达格列净单位成本，糖尿病 HFrEF 患者的 ICER 分别为 PHP132582（2560 美元）和 PHP120249（2321 美元）。通过涉及 10000 次迭代的蒙特卡罗模拟进行 PSA，并在成本效益接受曲线中绘制所得 ICER 与阈值 ICER 的关系，这些糖尿病 HFrEF 患者的 ICER 被确定为 72%和 76%具有成本效益。
从菲律宾公共医疗保健提供者的角度来看，达格列净联合标准治疗 HFrEF 患者可能具有成本效益。
