Krittayaphong Rungroj, Permsuwan Unchalee
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
Am J Cardiovasc Drugs. 2022 Sep;22(5):577-590. doi: 10.1007/s40256-022-00542-9. Epub 2022 Jul 7.
Clinical trials reported the benefit of empagliflozin when combined with standard treatment relative to cardiovascular death or heart failure (HF) hospitalization in patients with heart failure with reduced or preserved ejection fraction (HFrEF and HFpEF, respectively). We conducted a cost-utility analysis of combination empagliflozin and standard treatment (ST) versus ST alone in Thai HF patients with HFrEF or HFpEF.
A Markov model was employed to capture lifetime direct medical costs and outcomes from a healthcare system perspective. Two cohorts (HFrEF and HFpEF) with an average age of 60 years were enrolled. The clinical inputs were the results of the EMPEROR-Reduced and EMPEROR-Preserved studies, and a Thai database. Costs were gathered from published studies or from a Thai hospital database. Utilities were obtained from published studies. All costs and outcomes were discounted at a rate of 3% per annum. Incremental cost-effectiveness ratios (ICERs) were estimated, and sensitivity analyses were performed.
In patients with HFrEF, add-on empagliflozin yielded a life-year gain of 0.26, and a quality-adjusted life-year (QALY) gain of 0.20 at an increased total cost of 409.82 USD compared to ST alone [ICER: 69,218 THB/QALY (2064.98 USD/QALY gained)]. Among HFpEF patients, add-on empagliflozin yielded a life-year gain of 0.07, and a QALY gain of 0.05 at an increased total cost of 622.49 USD compared to ST alone [ICER: 395,826 THB/QALY (11,809 USD/QALY gained)].
At the local Thai threshold of 4773.27 USD/QALY, empagliflozin is a cost-effective add-on treatment for patients with HFrEF, but not for patients with HFpEF.
临床试验报告称，恩格列净与标准治疗联合使用时，相对于射血分数降低或保留的心力衰竭患者（分别为HFrEF和HFpEF）的心血管死亡或心力衰竭（HF）住院有获益。我们对泰国HFrEF或HFpEF心力衰竭患者中恩格列净与标准治疗（ST）联合使用与单独使用ST进行了成本效用分析。
采用马尔可夫模型从医疗保健系统角度获取终身直接医疗成本和结果。纳入了两个平均年龄为60岁的队列（HFrEF和HFpEF）。临床输入为EMPEROR-Reduced和EMPEROR-Preserved研究的结果以及一个泰国数据库。成本从已发表的研究或泰国医院数据库中收集。效用值从已发表的研究中获取。所有成本和结果均按每年3%的贴现率进行贴现。估计了增量成本效益比（ICER），并进行了敏感性分析。
在HFrEF患者中，与单独使用ST相比，加用恩格列净可使生命年增加0.26，质量调整生命年（QALY）增加0.20，总成本增加409.82美元[ICER：69,218泰铢/QALY（获得2064.98美元/QALY）]。在HFpEF患者中，与单独使用ST相比，加用恩格列净可使生命年增加0.07，QALY增加0.05，但总成本增加622.49美元[ICER：395,826泰铢/QALY（获得11,809美元/QALY）]。
在泰国当地每QALY4773.27美元的阈值下,恩格列净对于HFrEF患者是一种具有成本效益的附加治疗，但对于HFpEF患者则不然。
