Jiang Yaohui, Zheng Rujie, Sang Haiqiang
Department Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Pharmacol. 2021 Nov 11;12:733681. doi: 10.3389/fphar.2021.733681. eCollection 2021.
To evaluate the economics and effectiveness of adding dapagliflozin or empagliflozin to the standard treatment for heart failure (HF) for patients with reduced ejection fraction (HFrEF) in China. A Markov model was developed to project the clinical and economic outcomes of adding dapagliflozin or empagliflozin to the standard treatment for 66-year-old patients with HFrEF. A cost-utility analysis was performed based mostly on data from the empagliflozin outcome trial in patients with chronic heart failure and a reduced ejection fraction (EMPEROR-Reduced) study and the dapagliflozin and prevention of adverse outcomes in heart failure (DAPA-HF) trial. The primary outcomes were measured total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). In China, compared to the standard treatment, although adding dapagliflozin to the standard treatment in the treatment of HFrEF was more expensive ($4,870.68 vs. $3,596.25), it was more cost-effective (3.87 QALYs vs. 3.64 QALYs), resulting in an ICER of $5,541.00 per QALY. Similarly, adding empagliflozin was more expensive ($5,021.93 vs. $4,118.86) but more cost-effective (3.66 QALYs vs. 3.53 QALYs), resulting in an ICER of $6,946.69 per QALY. A sensitivity analysis demonstrated the robustness of the model in identifying cardiovascular death as a significant driver of cost-effectiveness. A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per QALY, the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively. A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on ICER. Compared with standard treatments with or without empagliflozin, adding dapagliflozin to the standard treatment in the treatment of HFrEF in China was extremely cost-effective.
评估在中国对射血分数降低的心力衰竭（HFrEF）患者在标准治疗基础上加用达格列净或恩格列净治疗心力衰竭（HF）的经济学效益和有效性。构建了一个马尔可夫模型，以预测在66岁HFrEF患者的标准治疗基础上加用达格列净或恩格列净后的临床和经济结局。成本效用分析主要基于慢性心力衰竭射血分数降低患者的恩格列净结局试验（EMPEROR-Reduced）研究以及达格列净治疗与预防心力衰竭不良结局试验（DAPA-HF）的数据进行。主要结局指标为总成本、增量成本、质量调整生命年（QALY）和增量成本效果比（ICER）。在中国，与标准治疗相比，虽然在HFrEF治疗中标准治疗基础上加用达格列净更昂贵（4870.68美元对3596.25美元），但更具成本效益（3.87个QALY对3.64个QALY），ICER为每QALY 5541.00美元。同样，加用恩格列净更昂贵（5021.93美元对4118.86美元）但更具成本效益（3.66个QALY对3.53个QALY），ICER为每QALY 6946.69美元。敏感性分析表明该模型在将心血管死亡确定为成本效益的重要驱动因素方面具有稳健性。概率敏感性分析表明，当支付意愿为每QALY 11008.07美元时，加用达格列净或恩格列净具有成本效益的概率分别为70.5%和55.2%。情景分析表明，住院费用、糖尿病状态和时间范围对ICER的影响更大。与含或不含恩格列净的标准治疗相比，在中国HFrEF治疗中标准治疗基础上加用达格列净极具成本效益。
