OBJECTIVES: In type 2 diabetes (T2D) patients with established CV disease, empagliflozin reduced heart failure hospitalizations (HHF) and CV death compared to SoC, regardless of HF at baseline. Given the poor outcomes and economic burden of these comorbidities, we investigated the cost-effectiveness of empagliflozin on top of SoC in T2D patients with HF at baseline over a lifelong time horizon from a UK perspective.

METHODS: Discrete event simulation economic model was developed to project CV events including HHF, CV death, and kidney outcomes for EMPA-REG OUTCOME T2D patients with HF at baseline. Respective risk equations were derived using event-free survival curves with time-dependent covariates. Model validity was assessed by comparing predicted and observed outcomes at three years. UK unit costs of complications and QoL data were obtained from literature. The drug costs were from the British National Formulary and Monthly Index of Medical Specialties. Outcomes included event rates per 100 patient-years (PYs), life years (LYs), costs, and quality-adjusted life years (QALYs).

RESULTS: Patients on empagliflozin were projected to experience fewer events of 1st HHF (3.64 vs 4.61 per 100 PY) and recurrent HHF (2.78 vs 4.92 per 100 PY), CV deaths (6.07 vs 7.37 per 100 PY), and non-fatal MI (2.67 vs 3.31 per 100 PY), but higher event rate for non-fatal stroke (2.57 vs 1.54 per 100 PY), compared to SoC. Treatment with empagliflozin projected 1.22 LYs and 0.65 QALYs gained. Incremental Cost-Effectiveness Ratio (ICER) for empagliflozin compared with SoC was £434/QALY. Probabilistic sensitivity analyses suggested that the probability of empagliflozin being cost-effective in patients with T2D and HF at a threshold of £20,000/QALY was 89%.

CONCLUSIONS: Based on results of EMPA-REG OUTCOME, this cost effectiveness analysis suggests that empagliflozin on top of SoC is a cost-effective treatment option for patients with T2D and chronic HF from the UK NHS perspective.