Health Economics and Outcomes Research Ltd., Cardiff, UK.
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur J Heart Fail. 2023 Aug;25(8):1386-1395. doi: 10.1002/ejhf.2940. Epub 2023 Jul 11.
To determine the cost-effectiveness of dapagliflozin, added to usual care, in patients with heart failure (HF) with mildly reduced or preserved ejection fraction for the UK, German and Spanish payers using detailed patient-level data from the Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial.
A lifetime Markov state-transition cohort model was developed. Quartiles of the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ-TSS) defined health states and monthly transition count data informed transition probabilities. Multivariable generalized estimating equations captured the incidence of HF hospitalizations and urgent HF visits, while cardiovascular deaths and all-cause mortality were estimated using adjusted parametric survival models. Health state costs were assigned to KCCQ-TSS quartiles (2021 British pound [GBP]/Euro) and patient-reported outcomes were sourced from DELIVER. Future values of costs and effects were discounted according to country-specific rates. In the UK, dapagliflozin treatment was predicted to increase quality-adjusted life years (QALYs) and life-years by 0.231 and 0.354, respectively, and extend the time spent in the best quartile of KCCQ-TSS by 4.2 months. Comparable outcomes were projected for Germany and Spain. The incremental cost-effectiveness ratios were £7761, €9540 and €5343/QALY in the UK, Germany and Spain, respectively. According to regional willingness-to-pay thresholds, 91%, 89% and 92% of simulations in the UK, Germany and Spain, respectively, were cost-effective following probabilistic sensitivity analyses.
Dapagliflozin, added to usual care, is very likely cost-effective for HF with mildly reduced or preserved ejection fraction in several European countries.
使用来自 Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure（DELIVER）试验的详细患者水平数据，确定对于英国、德国和西班牙支付者而言，在射血分数轻度降低或保留的心衰（HF）患者中，与常规治疗相比加用达格列净的成本效益。
开发了一个终生马尔可夫状态转移队列模型。堪萨斯城心肌病问卷总症状评分（KCCQ-TSS）的四分位数定义了健康状态，每月的转移计数数据提供了转移概率。多变量广义估计方程捕捉了 HF 住院和紧急 HF 就诊的发生率，而心血管死亡和全因死亡率则使用调整后的参数生存模型进行估计。健康状态的成本被分配到 KCCQ-TSS 的四分位数（2021 年英镑/欧元），患者报告的结果来自 DELIVER。根据各国的贴现率对成本和效果的未来值进行贴现。在英国，达格列净治疗预计将分别增加 0.231 个质量调整生命年（QALY）和 0.354 个生命年，并将 KCCQ-TSS 最佳四分位数的时间延长 4.2 个月。德国和西班牙也预计会有类似的结果。在英国、德国和西班牙，增量成本效益比分别为 7761 英镑、9540 欧元和 5343 欧元/QALY。通过概率敏感性分析，在英国、德国和西班牙，分别有 91%、89%和 92%的模拟结果符合区域支付意愿阈值，达格列净加常规治疗是非常有效的。
在几个欧洲国家，与常规治疗相比，加用达格列净治疗射血分数轻度降低或保留的心衰非常可能具有成本效益。
