Background: Evidence suggests that adding dapagliflozin to the prior standard of care is cost-effective compared with the standard of care alone. The recent American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) guideline recommends the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with heart failure with reduced ejection fraction (HFrEF), but their relative cost-effectiveness is unknown.

OBJECTIVES: To evaluate the cost-effectiveness of dapagliflozin vs. empagliflozin in patients with HFrEF.

METHODS: Using a state-transition Markov model, we estimated the expected lifetime costs, QALYs, and incremental cost-effectiveness ratio (ICER) for dapagliflozin vs. empagliflozin for the treatment of HFrEF. Patients entered the model at the age of 65, and they were modeled over a lifetime horizon from the US healthcare system perspective. Clinical probabilities were derived from a network meta-analysis. We discounted all future costs and QALYs at an annual rate of 3%, and the costs were presented in 2022 U.S. dollars.

RESULTS: In the base case, the incremental expected lifetime cost of treatment with dapagliflozin compared with empagliflozin was $37,684, yielding an ICER of $44,763/QALY. A price threshold analysis suggested that for empagliflozin to be the most cost-effective SGLT2 inhibitor at a WTP threshold of $50,000/QALY, it may need a 12% discount on its current annual prices.

CONCLUSIONS: This study demonstrated that dapagliflozin provides higher health and economic value than empagliflozin. Since the present clinical practice guideline did not indicate a preference for one SGLT2 inhibitor over another, scalable strategies are needed to ensure affordable access to this treatment.