Department Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
ESC Heart Fail. 2023 Aug;10(4):2524-2533. doi: 10.1002/ehf2.14426. Epub 2023 Jun 8.
The DELIVER study demonstrates a significant improvement in cardiovascular death or hospitalization for heart failure among heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF).Cost-utility of the adjunct use of dapagliflozin to standard therapy among patients with HFpEF or HFmrEF remains unclear.
A five-state Markov mode was constructed to project health and clinical outcomes of the adjunct use of dapagliflozin to standard therapy among 65-year-old patients with HFpEF or HFmrEF. A cost-utility analysis was performed based on the DELIVER study and national statistical database. The cost and utility was inflated to 2022 by the usual discount rate of 5%. The primary outcomes were total cost and quality-adjusted life-years (QALYs) per patients as well as the incremental cost-effectiveness ratio. Sensitivity analyses were also applied. Over a 15 year lifetime horizon, the average cost per patient was $7245.77 and $5407.55 in the dapagliflozin group and the standard group, along with an incremental cost of $1838.22. The average QALYs per patient was 6.00 QALYs and 5.84 QALYs in the dapagliflozin group and the standard group, along with an incremental QALYs of 0.15 QALYs, resulting in the incremental cost-effectiveness ratio of $11 865.33/QALY, which was below the willingness-to-pay (WTP) of $12 652.5/QALY. The univariate sensitivity analysis indicated the cardiovascular death in both group was the most sensitive variable. Probability sensitivity analysis revealed that when the WTP thresholds were $12 652.5/QALY and $37 957.5/QALY, the probabilities of being cost-effective with dapagliflozin as an add-on were 54.6% and 71.6%, respectively.
From a public healthcare system perspective, the adjunct use of dapagliflozin to standard therapy among patients with HFpEF or HFmrEF generated advantages in cost-effectiveness in China at a WTP of $12 652.5/QALY, which promoted the rational use of dapagliflozin for heart failure.
DELIVER 研究表明，在射血分数轻度降低的心力衰竭（HFmrEF）或射血分数保留的心力衰竭（HFpEF）患者中，使用达格列净作为附加治疗可显著降低心血管死亡或心力衰竭住院风险。在 HFpEF 或 HFmrEF 患者中，附加使用达格列净的成本-效用尚不清楚。
构建了一个五状态马尔可夫模型，以预测 HFpEF 或 HFmrEF 患者附加使用达格列净的标准治疗对健康和临床结局的影响。基于 DELIVER 研究和国家统计数据库进行成本-效用分析。按通常的 5%贴现率将成本和效用贴现至 2022 年。主要结局指标为每位患者的总费用和质量调整生命年（QALY）以及增量成本-效果比。还进行了敏感性分析。在 15 年的生命周期内，达格列净组和标准组每位患者的平均成本分别为 7245.77 美元和 5407.55 美元，增量成本为 1838.22 美元。达格列净组和标准组每位患者的平均 QALY 分别为 6.00 QALY 和 5.84 QALY，增量 QALY 为 0.15 QALY，增量成本-效果比为 11865.33 美元/QALY，低于 12652.5 美元/QALY 的意愿支付阈值。单因素敏感性分析表明，两组的心血管死亡是最敏感的变量。概率敏感性分析显示，当意愿支付阈值为 12652.5 美元/QALY 和 37957.5 美元/QALY 时，达格列净作为附加治疗的成本效益概率分别为 54.6%和 71.6%。
从公共医疗保健系统的角度来看，在中国，以 12652.5 美元/QALY 的意愿支付阈值，HFpEF 或 HFmrEF 患者标准治疗附加使用达格列净具有成本效益优势，促进了达格列净在心力衰竭治疗中的合理应用。
