依那普利在英国心力衰竭患者（无论射血分数如何）中的成本效益。
Cost-effectiveness of empagliflozin in heart failure patients irrespective of ejection fraction in England.
机构信息
IQVIA, Athens, Greece.
Boehringer Ingelheim Ltd., Berkshire, UK.
出版信息
J Cardiovasc Med (Hagerstown). 2023 Oct 1;24(10):758-764. doi: 10.2459/JCM.0000000000001532. Epub 2023 Jul 25.
AIMS
Heart failure (HF) is a complex syndrome commonly categorized into two main phenotypes [left ventricular ejection fraction (LVEF) below or above 40%], and although empagliflozin is the first approved medication with proven clinical effectiveness for both phenotypes, its cost-effectiveness of treating the entire HF population remains unknown.
METHODS
The analysis was performed utilizing two preexisting, LVEF phenotype-specific cost-effectiveness models to estimate the cost-effectiveness of empagliflozin in adults for the treatment of symptomatic chronic HF, irrespective of ejection fraction (EF). The results of the phenotype-specific models were combined using a population-weighted approach to estimate the deterministic and probabilistic incremental cost-effectiveness ratios (ICERs).
RESULTS
Based on combined results, empagliflozin + standard of care (SoC) is associated with 6.13 life-years (LYs) and 3.92 quality-adjusted life-years (QALYs) compared with 5.98 LYs and 3.76 QALYs for SoC alone over a lifetime, resulting in an incremental difference of 0.15 LYs and 0.16 QALYs, respectively. Total lifetime healthcare costs per patient are £15 246 for empagliflozin + SoC and £13 982 for SoC giving an incremental difference of £1264. The ICER is £7757/QALY, which is substantially lower than the willingness-to-pay (WTP) of £30 000 per QALY used by NICE. The results of the probabilistic sensitivity analyses are in line with the deterministic results.
CONCLUSION
Empagliflozin is the first efficacious, approved, and cost-effective treatment option for all HF patients, irrespective of EF. The combined ICER was consistently below the WTP threshold. Therefore, empagliflozin offers value for money for the treatment of the full HF population in England.
目的
心力衰竭（HF）是一种常见的复杂综合征，通常分为两种主要表型[左心室射血分数（LVEF）低于或高于 40%]，尽管恩格列净是第一种被证明对两种表型均具有临床疗效的获批药物，但治疗整个 HF 患者人群的成本效益仍不清楚。
方法
本分析使用两种现有的、基于 LVEF 表型特异性的成本效益模型，估算无论射血分数（EF）如何，恩格列净在治疗有症状的慢性 HF 成人患者中的成本效益。使用人群加权方法对表型特异性模型的结果进行组合，以估算确定性和概率性增量成本效益比（ICER）。
结果
根据综合结果，与单独使用标准治疗（SoC）相比，恩格列净+SoC 可使患者的终生生命年（LY）和质量调整生命年（QALY）分别增加 6.13 年和 3.92 年，而单独使用 SoC 则分别为 5.98 年和 3.76 年，分别增加 0.15 年和 0.16 年。每个患者的终生医疗保健总成本分别为恩格列净+SoC 组为 15246 英镑，SoC 组为 13982 英镑，差值为 1264 英镑。ICER 为每 QALY7757 英镑，远低于 NICE 采用的 30000 英镑/QALY 的意愿支付（WTP）阈值。概率敏感性分析的结果与确定性结果一致。
结论
恩格列净是第一种针对所有 HF 患者（无论 EF 如何）均有效、获批且具有成本效益的治疗选择。综合 ICER 始终低于 WTP 阈值。因此，恩格列净为英格兰 HF 全人群的治疗提供了物有所值。
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