Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction

Key Points

Question

Is the addition of dapagliflozin to guideline-directed medical therapy cost-effective for the treatment of heart failure with reduced ejection fraction?

Findings

In this economic evaluation of a simulated cohort of US adults with heart failure, adding dapagliflozin to guideline-directed medical therapy was projected to prolong survival by 0.63 quality-adjusted life-years while increasing lifetime costs by $42 800, producing an incremental cost-effectiveness ratio of $68 300 per quality-adjusted life-year. Results in individuals with and without diabetes were similar.

Meaning

These results suggest that widespread uptake of dapagliflozin for the treatment of heart failure with reduced ejection fraction has the potential to improve long-term clinical outcomes and is likely to meet conventional cost-effectiveness thresholds.

Abstract

This economic evaluation examined the cost-effectiveness of adding dapagliflozin to guideline-directed medical therapy for heart failure with reduced ejection fraction in a simulated cohort of patients with or without diabetes.

Abstract

Importance

Heart failure with reduced ejection fraction produces substantial morbidity, mortality, and health care costs. Dapagliflozin is the first sodium-glucose cotransporter 2 inhibitor approved for the treatment of heart failure with reduced ejection fraction.

Objective

To examine the cost-effectiveness of adding dapagliflozin to guideline-directed medical therapy for heart failure with reduced ejection fraction in patients with or without diabetes.

Design, Setting, and Participants

This economic evaluation developed and used a Markov cohort model that compared dapagliflozin and guideline-directed medical therapy with guideline-directed medical therapy alone in a hypothetical cohort of US adults with similar clinical characteristics as participants of the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) trial. Dapagliflozin was assumed to cost $4192 annually. Nonparametric modeling was used to estimate long-term survival. Deterministic and probabilistic sensitivity analyses examined the impact of parameter uncertainty. Data were analyzed between September 2019 and January 2021.

Main Outcomes and Measures

Lifetime incremental cost-effectiveness ratio in 2020 US dollars per quality-adjusted life-year (QALY) gained.

Results

The simulated cohort had a starting age of 66 years, and 41.8% had diabetes at baseline. Median (interquartile range) survival in the guideline-directed medical therapy arm was 6.8 (3.5-11.3) years. Dapagliflozin was projected to add 0.63 (95% uncertainty interval [UI], 0.25-1.15) QALYs at an incremental lifetime cost of $42 800 (95% UI, $37 100-$50 300), for an incremental cost-effectiveness ratio of $68 300 per QALY gained (95% UI, $54 600-$117 600 per QALY gained; cost-effective in 94% of probabilistic simulations at a threshold of $100 000 per QALY gained). Findings were similar in individuals with or without diabetes but were sensitive to drug cost.

Conclusions and Relevance

In this study, adding dapagliflozin to guideline-directed medical therapy was projected to improve long-term clinical outcomes in patients with heart failure with reduced ejection fraction and be cost-effective at current US prices. Scalable strategies for improving uptake of dapagliflozin may improve long-term outcomes in patients with heart failure with reduced ejection fraction.