Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.
Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts.
Clin Ther. 2023 Jul;45(7):627-632. doi: 10.1016/j.clinthera.2023.05.002. Epub 2023 Jun 1.
Evidence suggests that adding dapagliflozin to the prior standard of care is cost-effective compared with the standard of care alone. The latest guideline by the American Heart Association/American College of Cardiology/Heart Failure Society of America now recommends the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with heart failure with reduced ejection fraction (HFrEF). However, the relative cost-effectiveness of different SGLT2 inhibitors, including dapagliflozin and empagliflozin, has not been fully characterized. Therefore, we conducted a cost-effectiveness analysis to compare dapagliflozin and empagliflozin in patients with HFrEF from the US health care perspective.
To compare the cost-effectiveness of dapagliflozin and empagliflozin in treating HFrEF, we used a state-transition Markov model. This model was used to estimate the expected lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) for both medications. The model incorporated patients who were 65 years of age at entry and simulated their health outcomes over a lifetime horizon. The perspective of the analysis was based on the US health care system. To determine the health state transition probabilities, we used a network meta-analysis. All future costs and QALYs were discounted at an annual rate of 3%, and the costs were presented in 2022 US dollars.
The base case analysis found that the incremental expected lifetime cost of treating patients with dapagliflozin vs empagliflozin was $37,684, resulting in an ICER of $44,763 per QALY. A price threshold analysis indicated that for empagliflozin to be the most cost-effective SGLT2 inhibitor at a willingness-to-pay threshold of $50,000 per QALY, it may require a 12% discount on its current annual prices.
The findings of this study indicate that dapagliflozin may offer greater lifetime economic value when compared with empagliflozin. Given that the current clinical practice guideline does not recommend one SGLT2 inhibitor over the other, it is essential to implement scalable strategies to ensure affordable access to both medications. By doing so, patients and health care practitioners can make informed decisions about their treatment options without being constrained by financial barriers.
有证据表明，与单独的标准治疗相比，在标准治疗的基础上添加达格列净具有成本效益。美国心脏协会/美国心脏病学会/美国心力衰竭学会的最新指南现在建议对射血分数降低的心力衰竭（HFrEF）患者使用钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂。然而，不同 SGLT2 抑制剂（包括达格列净和恩格列净）的相对成本效益尚未得到充分描述。因此，我们进行了一项成本效益分析，以比较 HFrEF 患者使用达格列净和恩格列净的情况。
为了比较达格列净和恩格列净治疗 HFrEF 的成本效益，我们使用了状态转移马尔可夫模型。该模型用于估计两种药物的预期终生成本、质量调整生命年（QALY）和增量成本效益比（ICER）。该模型纳入了 65 岁时进入研究的患者，并模拟了他们的终生健康结果。分析的视角基于美国医疗保健系统。为了确定健康状态转移概率，我们使用了网络荟萃分析。所有未来的成本和 QALYs 均以每年 3%的贴现率贴现，成本以 2022 年的美元表示。
基础案例分析发现，治疗达格列净患者与恩格列净患者的预期终生增量成本为 37684 美元，导致每 QALY 的 ICER 为 44763 美元。价格阈值分析表明，要使恩格列净成为最具成本效益的 SGLT2 抑制剂，其当前的年价格可能需要降低 12%，在愿意支付的阈值为每 QALY 50000 美元时。
本研究结果表明，与恩格列净相比，达格列净可能具有更大的终生经济价值。鉴于当前的临床实践指南并未推荐一种 SGLT2 抑制剂优于另一种，因此实施可扩展的策略以确保两种药物都能负担得起至关重要。这样做可以使患者和医疗保健从业者在做出治疗选择时不会受到经济障碍的限制，从而能够做出明智的决策。
