OBJECTIVES:

Economic models with varying structures and assumptions have been applied in CEAs to assist decision-making for HFrEF therapeutics. This systematic review aims to summarise the model-based CEAs of GDMT for HFrEF.

METHODS:

A systematic search of English articles, published from 2010-2022, was performed on MEDLINE, Embase, Scopus, NHSEED, HTA and the Cochrane Library. Grey literature was searched using INAHTA, ProQuest and Informit. Backward citation tracking was conducted on the review articles. All CEAs comparing the costs and outcomes of angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker (BB), mineralocorticoid receptor agonist (MRA) and sodium-glucose co-transporter-2 inhibitor (SGLT-2i), using a decision-analytic model, were included.

RESULTS:

Searches identified 823 articles. 53 CEAs were included for structured narrative synthesis. Markov model (n=44) was the most commonly used model, followed by discrete-event simulation (n=8) and decision tree (n=1). ARNI was the most evaluated HFrEF therapeutics (n=28), followed by SGLT-2i (n=12) and MRA (n=9). Of the 28 studies, 23 reported ARNI being cost-effective, 2 maybe cost-effective, 2 not cost-effective and 1 not cost-saving. While all SGLT-2i analyses (dapagliflozin: n=10; empagliflozin: n=3) concluded cost-effective, three-quarters studies (n=7) demonstrated MRA (eplerenone) being cost-effective. Due to the heterogeneity of cost, effectiveness and cost-effectiveness estimates, the generalisability of the study conclusions to individual country is questionable due to the differences in model structures, comparators and assumptions. Despite the United States (n=11), the United Kingdom (n=11) and Australia (n=7) contributed the highest number of CEAs, there was an encouraging increase in publications among the Asian countries since 2015 (n=12).

CONCLUSIONS:

Markov model is suitable to evaluate the costs and outcomes of HFrEF GDMT. There is a need to conduct country-specific CEAs to inform resource allocation, particularly in low-middle income countries where access to HFrEF therapeutics with proven clinical effectiveness is limited by the costs.