Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Chronic Heart Failure Irrespective of Left-Ventricle Ejection Fraction in the Netherlands

OBJECTIVES:

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been found to be an effective treatment for patients with type-2 diabetes. Two clinical studies have now shown the efficacy of the SGLT2i empagliflozin in patients suffering from chronic heart failure with left-ventricle ejection fraction (LVEF) being either reduced (rEF) or preserved (pEF). This study aims to estimate the cost-effectiveness of empagliflozin added to standard-of-care (SoC) compared to SoC in adult patients suffering from chronic heart failure with either rEF or pEF.

METHODS:

A Markov-model was build using the New-York Heart Association (NYHA) classification of states I, II and III/IV, paired with states for hospitalisation due to heart failure, mortality due to heart failure or other causes. Transition probabilities, time-to-event data and utilities for the NYHA states along with disutility’s for the clinical events were sourced from the EMPEROR-Reduced and -Preserved trials for rEF and pEF, respectively. Costs were included to represent the Dutch setting from a societal perspective with a willingness-to-pay threshold of €50,000. The deterministic results of the two models were tested using a probabilistic sensitivity analysis (PSA) with 1,000 repetitions.

RESULTS:

Deterministically, the utilisation of empagliflozin in the treatment of patients with rEF resulted in a dominant incremental cost-effectiveness ratio (ICER), whereas the ICER for the pEF setting was determined to be €5,606 per quality adjusted life year. Especially, the management costs, productivity losses and informal care prevented through less hospitalisations are key drivers in both ICERs. PSA results were confirmed, with the likelihood of empagliflozin to be cost-effective being equal to 97% and 99% for rEF and pEF, respectively.

CONCLUSIONS:

Empagliflozin is a highly cost-effective intervention, preventing hospitalisations due to heart-failure in patients with suffering from chronic heart-failure. This is the case irrespective of the level of LVEF, which is used to subgroup patients in the guidelines of the European Society of Cardiology.