OBJECTIVES: Aim of this study was to estimate the cost-effectiveness of dapagliflozin in Dutch patients with symptomatic chronic heart failure and a reduced ejection fraction when adding dapagliflozin to standard of care (SoC).

METHODS: The model-based analysis was performed according to Dutch guidelines by adopting a lifetime horizon and a societal perspective (including costs for heart failure treatment, travelling and informal care). In the Markov model for heart failure, disease progression was modelled through transitions between discrete health states characterized by KCCQ TSS quartiles with state-specific utilities and costs. Furthermore, hospitalizations for heart failure and urgent heart failure visits were associated with additional costs and utility decrements. Patient characteristics at initiation were based on the DAPA-HF trial and the CHECK-HF study, a study considered representative for the Dutch HF population. Transition rates, risks for events, mortality (all-cause mortality and cardiovascular specific mortality) and utilities were sourced from DAPA-HF trial data. Additional input parameters were obtained from the Dutch costing manual, literature, and clinical expert opinion.

RESULTS: Burden of disease analysis showed that the relevant cost-effectiveness threshold for the patient population was €50,000/QALY in the Netherlands. The base case analysis resulted in a 0.55 gain in QALYs and €3,593 higher costs for dapagliflozin + SoC compared to SoC alone. The resulting ICER was €6,507 per QALY gained. At a threshold of €50,000 per QALY, the probability that dapagliflozin was cost-effective was 100%. One-way sensitivity analysis and all scenario analyses resulted in ICERs below the €50,000/QALY threshold.

CONCLUSIONS: Dapagliflozin is a cost-effective treatment option for chronic symptomatic heart failure with reduced ejection fraction in the Netherlands.