OBJECTIVES: Sodium glucose transporter-2 inhibitors dapagliflozin and empagliflozin are useful to prevent hospitalizations and mortality among heart failure with reduced ejection fraction (HFrEF) patients. However, no clinical trials have been performed to assess comparative performance of these drugs. The objective of this project was to compare the cost-effectiveness of dapagliflozin and empagliflozin for treatment of HFrEF.

METHODS: We developed a Markov model to simulate a cohort of newly-diagnosed HFrEF patients from a payer perspective across a time horizon of five years. Transitional states included stable HFrEF, hospitalization, and death. Probability of medication-related outcomes were obtained from a meta-analysis of EMPORER-Reduced and DAPA-HF trials while other inputs were gathered from the literature and Red Book. A discount rate of 5% was applied to costs and utilities. Outcomes included hospitalization, mortality, costs, quality-adjusted life years (QALY), and the incremental cost-effectiveness ratio (ICER). A tornado diagram was performed to assess which factors had the greatest impact on the model, and one-way sensitivity analyses were conducted to probe these findings.

RESULTS: Treatment of HFrEF with dapagliflozin had greater utility (5.67 QALY) and higher total cost ($117,487.02) than treatment with empagliflozin (5.31 QALY, $102,836.95). There was an ICER of $40,839.99 per QALY gained with dapagliflozin as compared to empagliflozin treatment. The tornado diagram revealed that the model was sensitive to cost of both drugs at ± 15% base cost.

CONCLUSIONS: Results from this study suggest that dapagliflozin is a cost-effective treatment for HFrEF as compared to empagliflozin, though this finding is sensitive to drug cost.