Lou Yake, Hu Tianyang, Huang Jing
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Chongqing, 400010, China.
Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Am J Cardiovasc Drugs. 2023 Jan;23(1):47-57. doi: 10.1007/s40256-022-00550-9. Epub 2022 Oct 8.
Heart failure is a worldwide health problem and is the leading cause of hospitalization in older patients. Heart failure with preserved ejection fraction (HFpEF) accounts for about 38% of heart failure cases. The latest EMPEROR-Preserved study shows that empagliflozin can reduce the risk of hospitalization in HFpEF, but whether empagliflozin is cost-effective in HFpEF in a Chinese setting remained uninvestigated.
A simulation of lifetime horizon for a 72-year-old HFpEF patient was conducted using a Markov model. The primary outcome was incremental cost-effectiveness ratio (ICER), expressed as incremental costs per quality-adjusted life-year (QALY). Three times the per capita GDP of China was set as the willingness-to-pay (WTP) threshold. Empagliflozin was considered cost-effective if the ICER was below the WTP threshold, otherwise it would be regarded as not cost-effective. One-way sensitivity and probabilistic sensitivity analysis (PSA) were used to assess uncertainty.
After a simulation of lifetime horizon, a 72-year-old HFpEF patient is expected to have an expected QALY of 4.80 in the empagliflozin group, and 4.67 QALY with standard treatment. The costs of empagliflozin and standard treatment are 34,987 (US$5423) and 27,027 (US$4189) Chinese Yuan (CNY), respectively, with an ICER of 63,746 (US$9881)/QALY, lower than the WTP threshold. One-way sensitivity and PSA show that our results are robust.
In Chinese HFpEF patients, adding empagliflozin to standard treatment is cost-effective, but studies based on real-world data are needed.
心力衰竭是一个全球性的健康问题，是老年患者住院的主要原因。射血分数保留的心力衰竭（HFpEF）约占心力衰竭病例的38%。最新的EMPEROR-Preserved研究表明，恩格列净可降低HFpEF患者的住院风险，但在中国背景下恩格列净在HFpEF中是否具有成本效益仍未得到研究。
使用马尔可夫模型对一名72岁的HFpEF患者进行终身模拟。主要结局为增量成本效益比（ICER），以每质量调整生命年（QALY）的增量成本表示。将中国人均GDP的三倍设定为支付意愿（WTP）阈值。如果ICER低于WTP阈值，则认为恩格列净具有成本效益，否则将被视为不具有成本效益。采用单向敏感性分析和概率敏感性分析（PSA）评估不确定性。
经过终身模拟，恩格列净组中一名72岁的HFpEF患者预期的QALY为4.80，标准治疗组为4.67 QALY。恩格列净和标准治疗的成本分别为34,987元人民币（5423美元）和27,027元人民币（4189美元），ICER为63,746元人民币（9881美元）/QALY，低于WTP阈值。单向敏感性分析和PSA表明我们的结果具有稳健性。
在中国HFpEF患者中，在标准治疗基础上加用恩格列净具有成本效益，但需要基于真实世界数据的研究。
