Jiang Zehui, Chen Dong Xiao, Xiao Cai, Fu Ying, Zhang Jun
Faculty of Economics and Management, Jiangxi University of Chinese Medicine, Nanchang, China.
Manchester Centre for Health Economics, Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester, United Kingdom.
Front Pharmacol. 2025 May 23;16:1572289. doi: 10.3389/fphar.2025.1572289. eCollection 2025.
This study aims to synthesize evidence on the cost-effectiveness of dapagliflozin for heart failure (HF) with all ejection fractions (EF), Including heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF).
Literature searches were conducted in English-language databases (PubMed, web of science, Embase, Cochrane Library) and Chinese-language databases (CNKI, Wanfang Data, and Chongqing VIP) to identify studies of dapagliflozin for heart failure. The search was current to 3 October 2024.
Twenty-eight studies were identified in the systematic review and the overall quality was accepted. Studies were conducted across 15 countries including China, UK, US, Japan, South Korea, Singapore, Thailand, Australia, Egypt, Colombia, Philippines, Qatar, Canadian, German, and Spanish. Cost-effectiveness analyses of dapagliflozin were performed for HFrEF patients in all countries, HFpEF patients in the US and China, HFpEF/HFmrEF patients in the UK, Germany, Spain and China and HF patients in the UK, US, Korea and Thailand. Except for one study in Thailand, all studies showed that dapagliflozin is cost-effective. One study in Korea showed that the cost-effectiveness of dapagliflozin in patients with left ventricular EF (LVEF)≤40% was more pronounced than LVEF >40%. Four studies (two HFrEF and one HFpEF in the US and one HFrEF in China) showed that dapagliflozin was more cost-effective than empagliflozin. In the nine diabetes subgroup analyses, seven results showed that dapagliflozin was more cost-effective for patients with diabetes. The incremental cost-effectiveness ratios (ICER)were most sensitive to the cost of dapagliflozin and cardiovascular mortality in the uncertainty analysis.
Dapagliflozin is cost-effective in the treatment of HF with all ejection fractions. The cost-effectiveness of patients with LVEF≤40% (HErEF)was more pronounced than LVEF >40% (HFpEF and HFmrEF). Compared to empagliflozin, dapagliflozin may be more cost-effective.
本研究旨在综合分析达格列净治疗所有射血分数（EF）的心力衰竭（HF）的成本效益证据，包括射血分数降低的心力衰竭（HFrEF）、射血分数轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）。
在英文数据库（PubMed、科学网、Embase、Cochrane图书馆）和中文数据库（CNKI、万方数据和重庆维普）中进行文献检索，以确定有关达格列净治疗心力衰竭的研究。检索截至2024年10月3日。
在系统评价中识别出28项研究，总体质量可接受。研究在包括中国、英国、美国、日本、韩国、新加坡、泰国、澳大利亚、埃及、哥伦比亚、菲律宾、卡塔尔、加拿大、德国和西班牙在内的15个国家进行。对所有国家的HFrEF患者、美国和中国的HFpEF患者、英国、德国、西班牙和中国的HFpEF/HFmrEF患者以及英国、美国、韩国和泰国的HF患者进行了达格列净的成本效益分析。除泰国的一项研究外，所有研究均表明达格列净具有成本效益。韩国的一项研究表明，达格列净在左心室射血分数（LVEF）≤40%的患者中的成本效益比LVEF>40%的患者更为显著。四项研究（美国的两项HFrEF和一项HFpEF以及中国的一项HFrEF）表明，达格列净比恩格列净更具成本效益。在九项糖尿病亚组分析中，七项结果表明达格列净对糖尿病患者更具成本效益。在不确定性分析中，增量成本效益比（ICER）对达格列净成本和心血管死亡率最为敏感。
达格列净治疗所有射血分数的心力衰竭均具有成本效益。LVEF≤40%（HErEF）患者的成本效益比LVEF>40%（HFpEF和HFmrEF）患者更为显著。与恩格列净相比，达格列净可能更具成本效益。
