OBJECTIVES: Heart failure (HF) is a progressive condition wherein the heart is unable to pump blood sufficiently to meet the body’s needs for oxygen. Currently, there are no recommended evidence-based targeted treatments for the HF phenotype with ejection fraction >40% (HF>40%EF), and a combination of therapies aiming to relieve patients’ symptoms are used. The EMPEROR-Preserved trial showed that empagliflozin is clinically effective compared to placebo, both added to Standard of Care (SoC), for HF>40%EF. A Markov model was used to examine the cost-effectiveness of empagliflozin for HF>40%EF for the National Health Service England (NHSE).

METHODS: The modelling approach considered the current treatment landscape, and the EMPEROR-Preserved trial data, including capturing the trial’s primary outcomes (hospitalisation due to heart failure [hHF] and cardiovascular death). The model’s health states were based on Kansas City Cardiomyopathy Questionnaire (KCCQ) quartiles of the EMPEROR-Preserved population. Cost categories included drug acquisition and resource use, and disease and adverse events management. EQ-5D-3L utility data with UK tariffs were included. The model’s outcomes included costs, hHF, life-years (LY) and quality-adjusted LY (QALY). Outcomes were discounted at a 3.5% annual rate.

RESULTS: Over a lifetime horizon, empagliflozin+SoC compared to SoC alone resulted in increased LYs (6.87 vs. 6.79) and QALYs (4.30 vs. 4.20), and higher total lifetime costs (£11,499 vs. £10,092). The incremental cost-effectiveness ratio was £19,053/LY and £14,851/QALY, well below the willingness-to-pay threshold of £20,000. In addition, empagliflozin+SoC resulted in fewer hHF compared to SoC (7.38 vs 8.37 per 100 patient-years). Based on the 1,000 iterations in the probabilistic sensitivity analysis, there was a 56% probability that empagliflozin+SoC would be cost-effective vs SoC.

CONCLUSIONS: Empagliflozin has demonstrated to be the first efficient and cost-effective treatment option for HF>40%EF patients treated in the NHSE setting, which is largely due to its impact on reducing hHF and cardiovascular deaths.