OBJECTIVES:

To compare the cost-effectiveness of dapagliflozin vs. empagliflozin in managing patients with HFpEF from the US healthcare system perspective.

METHODS:

We developed a Markov model to simulate a cohort of patients with HFpEF (defined as having a left ventricular ejection fraction ≥50%) treated with dapagliflozin or empagliflozin. Transition probabilities between three health states (HFpEF, hospitalization for heart failure, and death), costs, and quality of life weight input variables were obtained from the literature. Finally, we estimated total expected costs, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratio (ICER) over a lifetime horizon. All future expected costs and QALYs were discounted at the rate of 3%. We conducted sensitivity analyses to demonstrate the robustness of the cost-effectiveness model findings.

RESULTS:

In the base-case analysis, dapagliflozin had an incremental expected lifetime cost of US$29,896 compared with empagliflozin, resulting in an ICER of US$36,902/QALY. Value-priced threshold analysis suggested that for empagliflozin to be cost-effective, it would need a 29% discount on its annual price. In a probabilistic sensitivity analysis, dapagliflozin would be the most preferred cost-effective option at willingness-to-pay (WTP) thresholds of US$100,000/QALY about 72% of the time.

CONCLUSIONS:

This cost-effectiveness analysis showed that, from the US healthcare system perspective, dapagliflozin was more cost-effective than empagliflozin, and its uptake may enhance long-term outcomes in HFpEF patients.