OBJECTIVES: Heart failure (HF) is associated with a considerable healthcare burden to NHS England (NHSE), and there remains a high unmet need for efficacious treatment options. Empagliflozin offers to fulfil this unmet need based on the EMPEROR-Reduced and EMPEROR-Preserved trials, demonstrating its efficacy and safety on top of standard of care (SoC) for the full HF population, independent of Ejection Fraction. Empagliflozin+SoC has been shown to be cost-effective compared to SoC alone for each of the two HF phenotypes alone. The combined health economic impact of empagliflozin for the full HF population treated in the NHSE setting was evaluated.

METHODS: A Markov model was designed to evaluate the incremental costs and health benefits of empagliflozin+SoC versus SoC alone, based on the respective HF phenotype trial from the NHSE perspective over a lifetime horizon. To evaluate the population level impact, the results of the two models were combined, using a weighting factor for each phenotype sourced from a primary care database analysis of the Clinical Practice Research Datalink. Life years (LYs), quality-adjusted LY (QALYs), and costs were sourced from each model. Weighted averages of the model outcomes were estimated. Probabilistic sensitivity analysis (PSA) was conducted by sampling the model results according to the weighting factor.

RESULTS: For a combined HF population, empagliflozin+SoC compared to SoC alone resulted in increased LYs (7.05 vs. 6.97), QALYs (3.92 vs. 3.76), and healthcare costs (£15,359 vs. £14,087), with an incremental cost-effectiveness ratio of £7,806/QALY, substantially below the £20,000/QALY willingness to pay threshold. Furthermore, the probability to be cost effective was 71%.

CONCLUSIONS: Empagliflozin is the first treatment to be shown to be an efficacious and cost-effective treatment option for all HF patients, irrespective of phenotype. For empagliflozin, HF patients’ treatment decision making should be independent of ejection fraction.