Zou Xinyu, He Xingchen, Shi Qingyang, Wang Si, Li Nan, Zhou Yiling, Hu Ming, Luo Li, Shen Yiwen, Zhu Ye, Lang Chim C, Zhu Zhiming, Tian Haoming, Li Sheyu
Department of Endocrinology and Metabolism, MAGIC China Center, West China Hospital of Sichuan University, Chengdu, China.
Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands.
Front Pharmacol. 2025 Feb 25;16:1527972. doi: 10.3389/fphar.2025.1527972. eCollection 2025.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors showed time-varying effects in heart failure and reduced ejection fraction (HFrEF), but corresponding cost-effectiveness in different timeframes remained poorly understood. This study estimated the time-varying cost-effectiveness of SGLT2 inhibitors in HFrEF from the perspective of the Chinese healthcare system.
Based on real-world individual patient data, a 2-year microsimulation model was constructed to evaluate the cost-effectiveness of adding SGLT2 inhibitors to standard therapy compared with standard therapy alone among patients with HFrEF. A published prediction model informed transition probabilities for all-cause death and hospitalization for heart failure. The time-varying effects of SGLT2 inhibitors, medical costs, and utility values were derived from the published literature. Scenario analyses in different timeframes were conducted to assess the trend of cost-effectiveness over time.
Compared with standard therapy alone, SGLT2 inhibitors plus standard therapy were found cost-effective at a willingness-to-pay (WTP) threshold of $12,741 per quality-adjusted life year (QALY) gained in 2 years. The incremental cost-effectiveness ratio (ICER) decreased from $12,346.07/QALY at 0.5 years to $9,355.66/QALY at 2 years. One-direction sensitivity analysis demonstrated that the cost-effectiveness of SGLT2 inhibitors was most sensitive to the cost of SGLT2 inhibitors, the cost of hospitalization for heart failure, the cost of standard therapy for heart failure, and the baseline risks of all-cause death and hospitalization for heart failure. Probabilistic sensitivity analysis proved the robustness of the results.
Adding SGLT2 inhibitors to standard therapy was found to be cost-effective in Chinese patients with HFrEF. Longer treatment appeared to be more economically favorable, but further explorations are warranted.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂在心力衰竭伴射血分数降低（HFrEF）患者中显示出随时间变化的效应，但在不同时间范围内相应的成本效益仍知之甚少。本研究从中国医疗保健系统的角度估计了SGLT2抑制剂在HFrEF患者中的随时间变化的成本效益。
基于真实世界的个体患者数据，构建了一个为期2年的微观模拟模型，以评估在HFrEF患者中，与单纯标准治疗相比，在标准治疗基础上加用SGLT2抑制剂的成本效益。一个已发表的预测模型为全因死亡和心力衰竭住院的转移概率提供了信息。SGLT2抑制剂的随时间变化的效应、医疗成本和效用值来自已发表的文献。进行了不同时间范围内的情景分析，以评估成本效益随时间的变化趋势。
与单纯标准治疗相比，在每获得1个质量调整生命年（QALY）的支付意愿（WTP）阈值为12,741美元的情况下，发现SGLT2抑制剂加标准治疗具有成本效益。增量成本效益比（ICER）从0.5年时的12,346.07美元/QALY降至2年时的9,355.66美元/QALY。单向敏感性分析表明，SGLT2抑制剂的成本效益对SGLT2抑制剂的成本、心力衰竭住院成本、心力衰竭标准治疗成本以及全因死亡和心力衰竭住院的基线风险最为敏感。概率敏感性分析证明了结果的稳健性。
在中国HFrEF患者中，发现标准治疗基础上加用SGLT2抑制剂具有成本效益。更长时间的治疗似乎在经济上更有利，但仍需进一步探索。
