Cost-Utility in Dapagliflozin vErsus SacubiTrIl-ValsartaN TherapY in Heart Failure With Reduced Ejection Fraction [DESTINY-HF]: A Pragmatic Randomized Controlled Trial-Based Economic Evaluation...
Author(s)
Krishna Tiwari, MBBS1, Pradeep Dwivedi, MD2, Muhammad Aaqib Shamim, MD1, Surjit Singh, DM1, Sneha Ambwani, MD1, Surender Deora, DM2, Atul Kaushik, DM2, Rahul Choudhary, DM2, Shoban Babu Varthya, MD1.
1AIIMS JODHPUR, JODHPUR, India, 2AIIMS JODHPUR, Jodhpur, India.
1AIIMS JODHPUR, JODHPUR, India, 2AIIMS JODHPUR, Jodhpur, India.
OBJECTIVES: Angiotensin Receptor-Neprilysin Inhibitors (ARNI) and Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) are first line drugs for heart failure with reduced ejection fraction (HFrEF). There is considerable cost differences between the two class of drugs. But there is uncertain evidence on difference in effectiveness between these two first-line options as there is lack of real world evidence and no head-to-head randomized controlled trials (RCTs) prior to this study. This research aimed to assess the relative cost utility to aid the choice of one drug over the other in HFrEF.
METHODS: In this pragmatic RCT, patients with HFrEF received either dapagliflozin or sacubitril/valsartan for sixteen weeks. Direct medical costs and quality of life (QoL) were used for this posthoc within-trial cost-utility analysis. QoL was measured using a disease-specific tool - the Kansas City Cardiomyopathy Questionnaire -23 (KCCQ-23). We converted the QoL to EQ-5D utilities using a validated method and used Indian population norms to find quality adjusted life years (QALYs).
RESULTS: 105 patients with mean age of 58±11 years and 26% females were randomly assigned, 52 in Dapagliflozin group and 53 in and Sacubitril/Valsartan group. Sacubitril/Valsartan was associated with an incremental cost of 3884.963 [95% CI 2711.350 to 5058.575] Indian National Rupees (INR) per patient, and an incremental utility of 0.003 [-0.009 to 0.015] QALYs. Sacubitril/Valsartan is associated with an incremental cost-utility of 1340255 INR per QALY. Used a willingness-to-pay threshold per QALY of 0.24 (0.12 - 0.30) of Indian GDP per capita (based upon a previous study), Sacubitril/Valsartan is associated with a <0.01% probability of being cost-effective. It reached a 1% probability of being cost-effective only at a greater WTP threshold of 0.7 GDP per capita.
CONCLUSIONS: Sacubitril-Valsartan may not be a cost-effective alternative to Dapagliflozin for HFrEF in the Indian setting. The results may differ for higher resource settings.
METHODS: In this pragmatic RCT, patients with HFrEF received either dapagliflozin or sacubitril/valsartan for sixteen weeks. Direct medical costs and quality of life (QoL) were used for this posthoc within-trial cost-utility analysis. QoL was measured using a disease-specific tool - the Kansas City Cardiomyopathy Questionnaire -23 (KCCQ-23). We converted the QoL to EQ-5D utilities using a validated method and used Indian population norms to find quality adjusted life years (QALYs).
RESULTS: 105 patients with mean age of 58±11 years and 26% females were randomly assigned, 52 in Dapagliflozin group and 53 in and Sacubitril/Valsartan group. Sacubitril/Valsartan was associated with an incremental cost of 3884.963 [95% CI 2711.350 to 5058.575] Indian National Rupees (INR) per patient, and an incremental utility of 0.003 [-0.009 to 0.015] QALYs. Sacubitril/Valsartan is associated with an incremental cost-utility of 1340255 INR per QALY. Used a willingness-to-pay threshold per QALY of 0.24 (0.12 - 0.30) of Indian GDP per capita (based upon a previous study), Sacubitril/Valsartan is associated with a <0.01% probability of being cost-effective. It reached a 1% probability of being cost-effective only at a greater WTP threshold of 0.7 GDP per capita.
CONCLUSIONS: Sacubitril-Valsartan may not be a cost-effective alternative to Dapagliflozin for HFrEF in the Indian setting. The results may differ for higher resource settings.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD277
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)