OBJECTIVES: The aim of this study is to evaluate the budget impact of empagliflozin for the treatment of patients with heart failure (HF) in Sweden from a payer's perspective over a three-years’ time horizon.

METHODS: Two Excel-based budget impact models were developed to compare a scenario with empagliflozin to a scenario with previous standard of care (SoC). Efficacy and safety outcomes, as well as drug utilisation data, were obtained from the EMPEROR-Reduced and the EMPEROR-Preserved trials. Drug acquisition and clinical event costs were obtained from published Swedish sources. The projected share uptakes for empagliflozin were 10%, 15% and 20% for 2022, 2023 and 2024, respectively. Results were reported as total annual and cumulative costs (SEK 2021), as well as number of clinical events experienced over the same period.

RESULTS: Given the projected uptake, the total three-year cumulative budget impact using empagliflozin were estimated to be SEK 4,597,211 for HF with reduced ejection fraction (EF) (HFrEF), and SEK 140,867,502 for HF with EF above 40%. This represents a budget increase of 0.04% and 1.7%, respectively. Over the three-year time horizon, the new scenario with empagliflozin resulted in 4.3% and 3,6% fewer HF-related hospitalisations, respectively for HFrEF and HF with EF above 40%, 1% and 2% fewer cardiovascular (CV) deaths, as well as a reduction in several adverse events (AE) (acute renal failure cases [by 1.4% and 0.8%, respectively for the two types of HF], hepatic injuries [by 1.5% and 4%], and hypoglycaemic events [by 0.5% and 1%]), compared to the reference scenario without empagliflozin.

CONCLUSIONS: Although the addition of empagliflozin resulted in higher drug acquisition costs, the overall budget impact in Sweden was estimated to be minimal. The modest budget increase highlights that the treatment costs associated with empagliflozin are largely mitigated by fewer HF-related hospitalizations, CV deaths, and several AEs.