Varghese Lijoy, Lin Weiqin, Linden Stephan, Lum Ai Ling, Sim David
Boehringer Ingelheim Pte Ltd, Singapore.
Department of Cardiology, National University Heart Centre Singapore Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Value Health Reg Issues. 2023 Mar;34:108-117. doi: 10.1016/j.vhri.2022.12.003. Epub 2023 Jan 18.
The prevalence of heart failure (HF) and its risk factors are high in Singapore. The EMPEROR-Reduced trial demonstrated that add-on empagliflozin resulted in a reduction in the risk of cardiovascular death or hospitalization for HF compared with standard of care (SoC). This study aimed to estimate the cost-effectiveness of empagliflozin+SoC versus SoC in patients with HF with reduced ejection fraction from a Singaporean healthcare perspective.
A Markov cohort model simulated progression through health states based on New York Heart Association classes over a lifetime horizon using a cycle length of 1 month. Transition probabilities, and the risk of transient events (hospitalization for HF and cardiovascular/all-cause death) were modeled based on the EMPEROR-Reduced trial. Costs for HF-related events, adverse events, and for monitoring were estimated from a combination of published literature and publicly available fees for public hospitals/polyclinics.
Empagliflozin+SoC was estimated to be very cost-effective versus SoC alone with an incremental cost-effectiveness ratio of<8000 Singapore Dollars/quality-adjusted life-year gained. The base-case results were robust as evidenced from the consistency of various scenario and sensitivity analyses performed. When using Kansas City Cardiomyopathy Questionnaire - Clinical Summary Score quartiles as the health states, the incremental cost-effectiveness ratio reduced significantly to 4625 Singapore Dollars/quality-adjusted life-year.
The use of empagliflozin on top of SoC represents a highly cost-effective solution for the treatment of patients with HF with reduced ejection fraction in Singapore when considering its efficacy, relative affordability, and the growing economic burden of HF in Singapore.
心力衰竭（HF）在新加坡的患病率及其危险因素的比例都很高。EMPEROR-Reduced试验表明，与标准治疗（SoC）相比，加用恩格列净可降低心血管死亡或因心力衰竭住院的风险。本研究旨在从新加坡医疗保健的角度评估恩格列净联合SoC与SoC相比，在射血分数降低的心力衰竭患者中的成本效益。
采用马尔可夫队列模型，基于纽约心脏协会分级，在终身范围内模拟健康状态的进展，周期长度为1个月。根据EMPEROR-Reduced试验对转移概率以及短暂事件（因心力衰竭住院和心血管/全因死亡）的风险进行建模。与心力衰竭相关事件、不良事件和监测的成本，是根据已发表的文献以及公立医院/综合诊所的公开费用估算得出的。
与单用SoC相比，恩格列净联合SoC被估计具有很高的成本效益，增量成本效益比<8000新加坡元/获得的质量调整生命年。各种情景分析和敏感性分析的一致性证明了基础案例结果的稳健性。当使用堪萨斯城心肌病问卷-临床总结评分四分位数作为健康状态时，增量成本效益比显著降至4625新加坡元/质量调整生命年。
考虑到恩格列净的疗效、相对可承受性以及新加坡心力衰竭日益加重的经济负担，在SoC基础上加用恩格列净对于治疗新加坡射血分数降低的心力衰竭患者而言，是一种极具成本效益的解决方案。
