OBJECTIVES: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been approved for treating heart failure with reduced ejection fraction (HFrEF). However, the cost-effectiveness of SGLT2i remains unclear in HF. This study aimed to evaluate the cost-effectiveness of adding SGLT2i to the standard of care (SOC) for patients with HF, using the SOC as the comparison.

METHODS: A 2-state (alive and dead) Markow model was developed to simulate the disease progression for patients with HFrEF. The transition probabilities for patients who received SOC were derived from the EMPEROR-Reduced Trial. We estimated the pooled hazard ratios(HRs) for all-cause mortality and heart failure hospitalization (HHF) for SGLT2i plus SOC vs.SOC using meta-analysis of EMPEROR-Reduced and DAPA-HF trials. Costs and utilities were extracted from published sources, and we used the incremental cost-effectiveness ratio (ICER) to determine the cost-effectiveness of SGLT2i. We used a discount rate of 3% and a 5-year study period. We performed one-way sensitivity analyses to examine the impact of uncertainties in the key inputs. A healthcare system perspective was used.

RESULTS: SGLT2i plus SOC was associated with decreased risks of all-cause mortality by 13% (HR, 0.87; 95% CI, 0.77-0.98) and HHF by 31% (HR, 0.69; 95%CI, 0.62-0.78) compared to SOC. In the base case, SGLT2i plus SOC had a higher cost ($69,530.68 vs. $62,104.00) and a higher health gain (2.64 quality-adjusted life years (QALYs) vs. 2.32 QALYs) than SOC over five years, resulting in an ICER of $24,159/QALY. Based on a willingness to pay of $ 50,000/QALY, SGLT2i plus SOC is cost-effective compared to SOC. The results from sensitivity analyses suggest that our conclusion is robust to parameter uncertainties.

CONCLUSIONS: For patients with HF, adding SGLT2i to SOC is associated with lower risks of all-cause mortality and HHF and would be a cost-effective treatment option compared with SOC.