Dapagliflozin Shown to Be Cost-effective Among Patients With HFrEF

Dapagliflozin may provide an intermediate cost-effectiveness value to patients with heart failure with reduced ejection fraction (HFrEF), in terms of overall life-years and quality-adjusted life-years (QALYs) gained, as well as cost per QALY gained, reports JAMA Cardiology.

The authors stated their goal for this study was “to estimate the cost-effectiveness of dapagliflozin therapy among patients with chronic HFrEF,” because while mortality and hospitalization benefits of the sodium-glucose co-transporter 2 (SGLT2) inhibitor are well known, its cost-effectiveness when added to standard-of-care (SOC) treatment is not.

Using a Markov cohort cost-effectiveness model into which were fed data on therapy effectiveness, transition probabilities, and utilities from the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial and literature, they estimated outcomes among patients with HFrEF, including those with diabetes or other health-related impairments. Their analysis took place in February 2021.

Gains from adding dapagliflozin to SOC treatment for HFrEF were seen in the additional life-years and QALYs gained, along with cost per QALY gained (incremental cost-effectiveness ratio [ICER]). The authors’ analysis produced 0.78 life-years gained and 0.46 QALYs gained from dapagliflozin use compared with SOC treatment alone. The corresponding cost savings were an incremental cost of $38,212, which translates into $83,650 for each QALY gained.

In addition, the authors found that a 43% drop in dapagliflozin cost—from $424 to $270 per month—would subsequently reduce the cost per QALY gained to below $50,000, or 40% less.

To be included in the analysis, patients had to be 18 years or older and have a left ventricular ejection fraction below 40%, New York Heart Association (NYHA) class II to IV heart failure, and N-terminal pro–B-type natriuretic peptide levels of at least 600 pg/mL.

Analysis from the authors’ Markov model also showed these benefits of dapagliflozin:

• An SOC cardiovascular (CV)-related mortality rate of 7.9 events per 100 person-years (an identical rate was seen in DAPA-HF)
• An identical CV mortality rate of 0.82 vs 0.82 (95% CI, 0.69-0.98) seen in DAPA-HF
• A gain of 0.13 fewer hospitalizations compared with the SOC group, which had 2 hospitalizations
• Among patients with and without diabetes, fewer incremental QALYs and costs, respectively:
  • With diabetes: 0.43 and $34,367, for an ICER of $79,726
  • Without diabetes: 0.49 and $42,191, for an ICER of $85,420
• Among patients with mild health impairment from their heart failure, those in the dapagliflozin arm lived 1 year longer and had 0.08 fewer hospitalizations, which equated to an incremental cost of $44,813 and $78,483/QALY gained.
• Among patients with moderate health impairment from their heart failure, those in the dapagliflozin arm lived an additional 6 months and had 0.18 fewer hospitalizations, which equated to an incremental cost of $30,262 and $97,608/QALY gained.

“This economic evaluation study demonstrates that dapagliflozin provides intermediate value among patients with HFrEF regardless of diabetes or heart failure–related health status,” the authors noted.

However, they also found that there need to be at least 44 months of continuous dapagliflozin effectiveness for the cost per QALY gained to drop below $150,000, and in order to sustain costs per QALY gained below both that amount and $100,000, CV mortality needs to be reduced by at least 8% and 14%, respectively.

Because less than 1% of all study participants had NYHA class IV disease, the overall effectiveness and cost-effectiveness of dapagliflozin in this patient group remain unknown. The authors note that additional studies are required in this area, as well as the duration of dapagliflozin effectiveness.

“Additional data regarding the magnitude of mortality reduction would improve the precision of cost-effectiveness estimates,” they concluded.

Reference

Parizo JT, Goldhaber-Fiebert JD, Salomon JA, et al. Cost-effectiveness of dapagliflozin for treatment of patients with heart failure with reduced ejection fraction. JAMA Cardiol. Published online May 26, 2021. doi:10.1001/jamacardio.2021.1437