Empagliflozin for Heart Failure Patients Irrespective of Ejection Fraction in Spain: A Cost-Effectiveness Study

OBJECTIVES: Heart failure (HF) is a chronic disease associated with substantial burden for healthcare providers and impairment in patients’ quality of life. There is still a high unmet need for efficacious and cost-effective treatment options. Empagliflozin offers to fill this treatment availability gap based on the EMPEROR-Reduced and EMPEROR-Preserved trials, demonstrating its efficacy on top of standard of care (SoC) for all HF patients, including HF with left ventricular ejection fraction (EF) ≤40% and >40%. Empagliflozin+SoC was cost-effective compared to SoC alone for each of the two HF phenotypes alone. The combined health economic impact of empagliflozin for the full HF population treated in Spain was investigated.

METHODS: A Markov model was developed evaluating the incremental costs and health benefits of empagliflozin+SoC versus SoC alone, for each respective HF phenotype trial. To evaluate the impact on the population level, the results of the two models were combined, using a weighting factor reflecting the incidence of each phenotype. Life years (LYs), quality-adjusted LY (QALYs), and healthcare costs were sourced from each model. Weighted averages of the models’ outcomes were estimated. Probabilistic sensitivity analysis was performed by sampling the model results according to the weighting factor.

RESULTS: Empagliflozin+SoC compared to SoC alone resulted in increased LYs (6.29 vs. 6.13), QALYs (4.69 vs. 4.50), and healthcare costs (€21,050 vs. €20,020), over a lifetime horizon for the combined HF population. The incremental cost-effectiveness ratio was €5,446/QALY. Furthermore, the probability for empagliflozin+SoC to be cost effective was 78%, for a €20,000 per QALY willingness to pay threshold.

CONCLUSIONS: Empagliflozin is the first treatment to be shown to be an efficacious and cost-effective treatment option for all HF patients, irrespective of HF phenotype. HF patients can be treated with empagliflozin independently of ejection fraction.