Arbel Ronen, Azab Abed N, Oberoi Mansi, Aboalhasan Enis, Star Artyom, Elhaj Khaled, Khalil Fouad, Alnsasra Hilmi
Maximizing Health Outcomes Research Lab, Sapir College, Ashkelon, Israel.
Department of Cardiology, Soroka University Medical Center, Beersheba, Israel.
Front Pharmacol. 2024 Mar 19;15:1357673. doi: 10.3389/fphar.2024.1357673. eCollection 2024.
Heart failure with preserved ejection fraction (HFpEF) is associated with an increased risk of heart failure (HF) hospitalizations and cardiovascular death (CVD). Both dapagliflozin and sacubitril-valsartan have recently shown convincing reductions in the combined risk of CVD and HF hospitalizations in patients with HF and mildly reduced ejection fraction (HFmrEF) or HFpEF. We aimed to investigate the cost-per-outcome implications of dapagliflozin vs sacubitril-valsartan in the treatment of HFmrEF or HFpEF patients.
We compared the annualized cost needed to treat (CNT) to prevent the composite outcome of total HF hospitalizations and CVD with dapagliflozin or sacubitril-valsartan. The CNT was estimated by multiplying the annualized number needed to treat (aNNT) by the annual cost of therapy. The aNNT was calculated based on data collected from the DELIVER trial for dapagliflozin and a pooled analysis of the PARAGLIDE-HF and PARAGON-HF trials for sacubitril-valsartan. Costs were based on 2022 US prices. Scenario analyses were performed to attenuate the differences in the studies' populations.
The aNNT with dapagliflozin in DELIVER was 30 (95% confidence interval [CI]: 21-62) 44 (95% CI: 25-311) with sacubitril-valsartan in a pooled analysis of PARAGLIDE-HF and PARAGON-HF, with an annual cost of $4,951 and $5,576, respectively. The corresponding CNTs were $148,547.13 (95% CI: $103,982.99-$306,997.39) for dapagliflozin and $245,346.77 (95% CI: $139,401.58-1,734,155.60) for sacubitril-valsartan for preventing the composite outcome of CVD and HF hospitalizations. The CNT for preventing all-cause mortality was lower for dapagliflozin than sacubitril-valsartan $1,128,958.15 [CI: $401,077.24-∞] vs $2,185,816.71 [CI: $607,790.87-∞].
Dapagliflozin provides a better monetary value than sacubitril-valsartan in preventing the composite outcome of total HF hospitalizations and CVD among patients with HFmrEF or HFpEF.
射血分数保留的心力衰竭（HFpEF）与心力衰竭（HF）住院和心血管死亡（CVD）风险增加相关。达格列净和沙库巴曲缬沙坦最近均显示，在射血分数轻度降低的心力衰竭（HFmrEF）或HFpEF患者中，可显著降低CVD和HF住院的综合风险。我们旨在研究达格列净与沙库巴曲缬沙坦治疗HFmrEF或HFpEF患者时每获得一个治疗效果的成本。
我们比较了使用达格列净或沙库巴曲缬沙坦预防HF住院和CVD综合结局所需的年化治疗成本（CNT）。CNT通过将年化治疗所需人数（aNNT）乘以每年的治疗费用来估算。aNNT根据从达格列净的DELIVER试验收集的数据以及沙库巴曲缬沙坦的PARAGLIDE-HF和PARAGON-HF试验的汇总分析计算得出。成本基于2022年美国价格。进行情景分析以减弱研究人群的差异。
在DELIVER试验中，达格列净的aNNT为30（95%置信区间[CI]：21 - 62），在PARAGLIDE-HF和PARAGON-HF的汇总分析中，沙库巴曲缬沙坦的aNNT为44（95% CI：25 - 311），每年成本分别为4,951美元和5,576美元。预防CVD和HF住院综合结局时，达格列净和沙库巴曲缬沙坦相应的CNT分别为148,547.13美元（95% CI：103,982.99美元 - 306,997.39美元）和245,346.77美元（95% CI：139,401.58美元 - 1,734,155.60美元）。预防全因死亡率时，达格列净的CNT低于沙库巴曲缬沙坦，分别为1,128,958.15美元[CI：401,077.24美元 - ∞]和2,185,816.71美元[CI：607,790.87美元 - ∞]。
在预防HFmrEF或HFpEF患者的HF住院和CVD综合结局方面，达格列净比沙库巴曲缬沙坦具有更好的货币价值。
