Liu Jinyu, Liu Dong, Gong Xuepeng, Wei Anhua, You Ruxu
Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Front Pharmacol. 2023 Jun 30;14:1186579. doi: 10.3389/fphar.2023.1186579. eCollection 2023.
This study aims to synthesize evidence on the cost-effectiveness of empagliflozin for heart failure (HF). MEDLINE, Embase, the Cochrane Library, EconLit, CNKI, Wanfang Data and Chongqing VIP were searched to identify original articles on cost-effectiveness of empagliflozin for HF, and literature surveillance ended on 20 November 2022. The reporting quality of the included articles was determined using the Consolidated Health Economic Evaluation Reporting Standards statement. Of 97 articles identified, 11 studies published from 2020 to 2022 met the inclusion criteria, and the overall quality was accepted. The studies were conducted in 8 countries (China, Japan, Korea, Singapore, Thailand, Australia, United States, and United Kingdom). This body of evidence suggested that add-on empagliflozin was cost effective for HF with reduced ejection fraction (HFrEF) patients compared to standard of care alone in all the related studies including China, Japan, Korea, Singapore, Thailand, and Australia. For HF with preserved ejection fraction (HFpEF) patients, add-on empagliflozin was cost effective in China and Australia, but not in United States and Thailand. For HF with diabetes, add-on empagliflozin was cost effective in United Kingdom. Moreover, the incremental cost-effectiveness ratios (ICER) were lower for patients with diabetes than without in subgroup analysis. In the uncertainty analysis of all included studies, the ICERs were most sensitive to the cost of empagliflozin and cardiovascular mortality, followed by the cost of the standard treatment, hazard ratio of HF hospitalization. add-on empagliflozin for HFrEF might be cost-effective or dominant compared with standard of care alone. However, for HFpEF patients, add-on empagliflozin might be cost-effective in China and Australian, but not cost-effective in United States and Thailand.
本研究旨在综合关于恩格列净治疗心力衰竭（HF）成本效益的证据。检索了MEDLINE、Embase、Cochrane图书馆、EconLit、中国知网、万方数据和重庆维普，以识别有关恩格列净治疗HF成本效益的原始文章，文献检索截至2022年11月20日。使用《卫生经济评估报告标准合并声明》确定纳入文章的报告质量。在识别出的97篇文章中，2020年至2022年发表的11项研究符合纳入标准，整体质量可接受。这些研究在8个国家（中国、日本、韩国、新加坡、泰国、澳大利亚、美国和英国）进行。这组证据表明，在包括中国、日本、韩国、新加坡、泰国和澳大利亚在内的所有相关研究中，与单纯标准治疗相比，加用恩格列净治疗射血分数降低的心力衰竭（HFrEF）患者具有成本效益。对于射血分数保留的心力衰竭（HFpEF）患者，加用恩格列净在中国和澳大利亚具有成本效益，但在美国和泰国则不然。对于合并糖尿病的HF患者，加用恩格列净在英国具有成本效益。此外，亚组分析中糖尿病患者的增量成本效益比（ICER）低于非糖尿病患者。在所有纳入研究的不确定性分析中，ICER对恩格列净成本和心血管死亡率最为敏感，其次是标准治疗成本、HF住院风险比。与单纯标准治疗相比，加用恩格列净治疗HFrEF可能具有成本效益或占优。然而，对于HFpEF患者，加用恩格列净在中国和澳大利亚可能具有成本效益，但在美国和泰国则不具有成本效益。
