Hallinen Taru, Kivelä Santtu, Soini Erkki, Harjola Veli-Pekka, Pesonen Mari
ESiOR Oy, Kuopio, Finland.
Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
Clinicoecon Outcomes Res. 2023 Jan 6;15:1-13. doi: 10.2147/CEOR.S391455. eCollection 2023.
Sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin has recently been shown to improve the outcomes of heart failure (HF) patients regardless of patient's left ventricular ejection fraction by reducing the combined risk of cardiovascular death or hospitalization for worsening HF. The aim of this study was to assess the cost-effectiveness of adding empagliflozin to the standard care (SC) in comparison to SC only in the treatment of HF in Finland.
The assessment was performed in the cost-utility framework using two Markov cohort state-transition models, one for HF with reduced ejection fraction (HFrEF) and one for HF with preserved ejection fraction (HFpEF). The models have been primarily developed based on the EMPEROR-Reduced and EMPEROR-Preserved trials which informed the modelled patient characteristics, efficacy of treatments in terms of associated risks for heart failure hospitalizations, cardiovascular (CV) and non-CV death, treatment related adverse events (AE), and state- and event-specific health-related quality of life weights (EQ-5D). Direct health care costs were estimated from Finnish published references. Cost-effectiveness was assessed from health care payer perspective based on incremental cost-effectiveness ratio (ICER; cost per quality adjusted life-year [QALY] gained) and probability of cost-effectiveness (at willingness-to-pay [WTP] of 35,000 euros/QALY). The ICER was reported as the weighted (HFrEF, 43.5%; HFpEF, 56.5%) average result of the two models.
Empagliflozin + SC treatment increased the average quality-adjusted life-expectancy, and treatment costs of HF patients by 0.15 QALYs and 1,594 euros, respectively, when compared to SC. An additional QALY with empagliflozin was thus gained at a cost of 10,621 euros. The probability of empagliflozin + SC being cost-effective compared to placebo + SC was 77.6% and 83.5% with WTP of 35,000 and 100,000 euros/QALY, respectively.
Empagliflozin is a cost-effective treatment for patients with HF in the Finnish health care setting.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂恩格列净最近被证明可降低心血管死亡或因心力衰竭恶化住院的综合风险，从而改善心力衰竭（HF）患者的预后，无论患者的左心室射血分数如何。本研究的目的是评估在芬兰，与仅采用标准治疗（SC）相比，在标准治疗基础上加用恩格列净治疗心力衰竭的成本效益。
在成本效用框架下，使用两个马尔可夫队列状态转换模型进行评估，一个用于射血分数降低的心力衰竭（HFrEF），另一个用于射血分数保留的心力衰竭（HFpEF）。这些模型主要基于EMPEROR-Reduced和EMPEROR-Preserved试验开发，这些试验为模型中的患者特征、治疗在心力衰竭住院相关风险、心血管（CV）和非CV死亡、治疗相关不良事件（AE）方面的疗效，以及特定状态和事件的健康相关生活质量权重（EQ-5D）提供了依据。直接医疗成本根据芬兰已发表的参考文献进行估算。从医疗保健支付方的角度，基于增量成本效益比（ICER；每获得一个质量调整生命年[QALY]的成本）和成本效益概率（支付意愿[WTP]为35,000欧元/QALY）评估成本效益。ICER报告为两个模型的加权（HFrEF，43.5%；HFpEF，56.5%）平均结果。
与标准治疗相比，恩格列净+标准治疗使心力衰竭患者的平均质量调整预期寿命增加了0.15个QALY，治疗成本增加了1594欧元。因此，每获得一个恩格列净治疗的QALY成本为10,621欧元。当支付意愿为35,000欧元/QALY和100,000欧元/QALY时，恩格列净+标准治疗与安慰剂+标准治疗相比具有成本效益的概率分别为77.6%和83.5%。
在芬兰医疗保健环境中，恩格列净是治疗心力衰竭患者的一种具有成本效益的治疗方法。
