OBJECTIVES : Dapagliflozin was recently demonstrated to be an effective treatment for heart failure with reduced ejection fraction (HFrEF) in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial when used in addition to standard therapy. Sacubitril/valsartan is an existing treatment for patients with symptomatic HFrEF receiving treatment with angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers. The objective of this study was to assess the cost-effectiveness of dapagliflozin+ACEi compared to sacubitril/valsartan + standard of care (SOC) for the treatment of HFrEF from a UK NHS perspective.

METHODS : A lifetime Markov model with health states defined by Kansas City Cardiomyopathy Total Symptom Score, type 2 diabetes and HF events was used to estimate outcomes for patients treated with either dapagliflozin+ACEi or sacubitril/valsartan+SOC. Efficacy and safety of both treatment strategies were assumed to be comparable based on a matching adjusted indirect comparison between DAPA-HF and PARADIGM-HF, with sensitivity analysis modelling the non-significant differences in efficacy between dapagliflozin+ACEi and sacubitril/valsartan+SOC. Cost and utility estimates were derived from published literature and DAPA-HF, respectively, and discounted at 3.5% per annum.

RESULTS : Treatment with Dapagliflozin+ACEi resulted in cost savings of £650 per treated patient over a one-year horizon, increasing to £3,197 over a lifetime horizon compared to sacubitril/valsartan+SOC. Sensitivity analysis including a non-significant reduction of the composite of hospitalization for HF or cardiovascular death (hazard ratio: 0.91 [95% confidence interval: 0.69-1.21] with dapagliflozin+ACEi compared to sacubitril/valsartan+SOC resulted in quality-adjusted life-year gains of 0.17 and cost savings of £2,578 per patient treated over a lifetime horizon.

CONCLUSIONS : In this study, treatment with dapagliflozin+ACEi resulted in significant cost savings to UK payers, with equivalent or better outcomes compared to sacubitril/valsartan+SOC in patients with HFrEF. Savings associated with dapagliflozin versus sacubitril/valsartan have the potential to significantly reduce the burden HFrEF imposes on healthcare systems.