Davis, J. A., Booth, D., McEwan, P., Solomon, S. D., McMurray, J. J.V. , de Boer, R. A., Comin‐Colet, J., Bachus, E. and Chen, J. (2024) Cost-effectiveness of dapagliflozin for patients with heart failure across the spectrum of ejection fraction: a pooled analysis of DAPA-HF and DELIVER data. European Journal of Heart Failure, 26(3), pp. 664-673. (doi: 10.1002/ejhf.3197) (PMID:38509642)
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Abstract
Aim: To assess the cost-effectiveness of dapagliflozin in addition to usual care, compared with usual care alone, in a large population of patients with heart failure (HF), spanning the full range of left ventricular ejection fraction (LVEF). Methods and results: Patient-level data were pooled from HF trials (DAPA-HF, DELIVER) to generate a population including HF with reduced, mildly reduced and preserved LVEF, to increase statistical power and enable exploration of interactions among LVEF, renal function and N-terminal pro-B-type natriuretic peptide levels, as they are relevant determinants of health status in this population. Survival and HF recurrent event risk equations were derived and applied to a lifetime horizon Markov model with health states defined by Kansas City Cardiomyopathy Questionnaire total symptom score quartiles; costs and utilities were in the UK setting. The base case incremental cost-effectiveness ratio (ICER) was £6470 per quality-adjusted life year (QALY) gained, well below the UK willingness-to-pay (WTP) threshold of £20 000/QALY gained. In interaction sensitivity analyses, the highest ICER was observed for elderly patients with preserved LVEF (£16 624/QALY gained), and ranged to a region of dominance (increased QALYs, decreased costs) for patients with poorer renal function and reduced/mildly reduced LVEF. Results across the patient characteristic interaction plane were mostly between £5000 and £10 000/QALY gained. Conclusions: Dapagliflozin plus usual care, versus usual care alone, yielded results well below the WTP threshold for the UK across a heterogeneous population of patients with HF including the full spectrum of LVEF, and is likely a cost-effective intervention.
Item Type: | Articles |
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Additional Information: | This work was supported by AstraZeneca who provided support for the analysis and medical writing for this study. |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
Authors: | Davis, J. A., Booth, D., McEwan, P., Solomon, S. D., McMurray, J. J.V., de Boer, R. A., Comin‐Colet, J., Bachus, E., and Chen, J. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | European Journal of Heart Failure |
Publisher: | Wiley |
ISSN: | 1388-9842 |
ISSN (Online): | 1879-0844 |
Published Online: | 20 March 2024 |
Copyright Holders: | Copyright © 2024 The Authors |
First Published: | First published in European Journal of Heart Failure 26(3):664-673 |
Publisher Policy: | Reproduced under a Creative Commons licence |
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