Objective: Heart Failure (HF) is a high-cost chronic disease with frequent worsening events requiring expensive hospital treatments. This study evaluated the cost-utility of dapagliflozin in patients with HF in Costa Rica.

Method: A Markov model was developed considering three states: HF, worsening HF, and death. The base case was patients with an ejection fraction of 40% or less and New York Heart Association class II, III, or IV symptoms. Perspective is from the third payer; comparators are dapagliflozin or no treatment. Outcomes are worsening HF and death and are expressed in Quality Adjusted Life Years (QALYs). There are two-time horizons, 12 and 24 months, based on the efficacy of the pivotal clinical trial of dapagliflozin in HF. Costs were estimated in an advisory board with cardiologists in Costa Rica. The Willingness-to-Pay (WTP) used was three times the gross domestic product per capita (USD 36,230).

Results: At 12 months of follow-up, the dapagliflozin strategy costs $1,248 and generates 0.938 QALYs, and without treatment, the cost is $1,075 and generates 0.923 QALYs. At 24 months, the strategy cost with dapagliflozin is $2,334 and generates 1.74 QALYs, and without treatment, it is $1,737 and generates 1.70 QALYs. The Incremental Cost-Effectiveness Ratio (ICER) at 12 months is $ 11,581 and at 24 months, it is $ 12,949 per additional QALY gained. Willingness-to-pay curves estimate that the probability that dapagliflozin is the best treatment strategy at 12 months is 61.3 %, and at 24 months, 57.4 %.

Conclusion: Dapagliflozin is a highly cost-effective strategy for treating HF in Costa Rica. The probability of worsening HF events requiring expensive hospital treatments is much lower in patients who receive dapagliflozin than in patients who do not receive it.