Dapagliflozin Linked to Cost-Effective, Improved Outcomes in Patients with HFrEF

Dhruv S. Kazi, MD

While heart failure remains a leading cause of hospitalization in the United States, the use of dapagliflozin in patients with heart failure with reduced ejection fraction (HFrEF) may help improve outcomes and reduce health care costs.

A recent study evaluated the cost-effectiveness of adding dapagliflozin to guideline-directed medical therapy (GDMT) for the management of HFrEF in patients with and without diabetes.

As a result, investigators, led by Dhruv S. Kazi, MD, Beth Israel Deaconess Medical Center, found the addition of dapagliflozin to GDMT was expected to improve clinical outcomes in patients with HFrEF and also be cost-effective according to current US prices.

Study

The team constructed a Markov cohort model to compare the 2 treatment strategies in patients with HFrEF, including GDMT and dapagliflozin and GDMT alone.

GDMT treatment consisted of an angiotensin converting enzyme inhibitor, an angiotensin-receptor blocker, or an angiotensin receptor neprilysin inhibitor. Dapaglifozin was 10mg once daily added to GDMT.

Investigators compared the treatments in a hypothetical cohort of similar US adults in the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) trial.

Inclusion criteria included patients with HFrEF who had a New York Heart Association class II, III, or IV symptoms and a left ventricular ejection fraction of ≤40%.

Exclusions included patients with an estimated glomerular filtration rate less than 30 mL/min/1.73 m2of the body surface.

The team noted that the net price of SGLT2is paid by payers in significantly lower than list price, as they valued the annual cost of dapagliflozin.

They assumed the agent would cost $4192 for a year’s supply, using data from August 2020.

In addition, investigators used a nonparametric model to estimate long-term survival of patients, while deterministic and probabilistic sensitivity analyses examined the impact of parameter uncertainty.

The main outcome was the lifetime incremental cost-effectiveness ratio in 2020 US dollars per quality-adjusted life-year (QALY) gained.

Results

Investigators noted the simulated cohort had a starting age of 66 years, with 41.8% having diabetes at baseline. Further, the median survival in the GDMT arm of the study was found to be 6.8 years.

Data show the addition of dapagliflozin to GDMT in patients with HFrEF was projected to lower the rate of HFpEF hospitalizations from 0.10 (95% CI, 0.09 - 0.11) to 0.07 (95% CI, 0.06 - 0.08) per person-year.

They observed the addition would improve quality-adjusted survival by 0.63 (95% uncertainty interval UI, 0.25 - 1.15) QALYs.

After accounting for increased health care costs as related to improved survival rates, the intervention arm had a net increase in lifetime health care costs of $42,800 (95% UI, $37,100 - $50,300).

This resulted in an incremental cost-effectiveness ratio of $68,300 per QALY gained (95% UI, $54,600 - $117,600 per QALY gained) compared to GDMT alone.

In addition, data show dapagliflozin was cost effective in 94% of probabilistic simulations at a threshold of $100,000 per QALY gained.

Conclusion

The team concluded that the addition of dapagliflozin to GDMT would produce significant clinical gains in patients with HFrEF, with an acceptable increase in associated costs.

“At a willingness-to-pay threshold of $100 000 per QALY gained, treatment with dapagliflozin, at an annual cost of $4192, would be cost-effective therapy in patients with HFrEF regardless of whether treated patients have diabetes,” investigators wrote. “Scalable strategies to ensure affordable access to and widespread uptake of dapagliflozin are urgently needed.”

The study, “Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction,” was published online in JAMA Network Open.