Rapid Initiation of SGLT2 Inhibitors Improves Cost-Effectiveness of Therapy, with Ankeet Bhatt, MD, MBA

New research presented at the American Heart Association (AHA) Annual Scientific Sessions 2024 is underlining the importance of early, rapid uptitration of guideline-directed medical therapy and avoiding unnecessary expenses in patients with heart failure.

An analysis of the cost-effectiveness of dapagliflozin (Farxiga) among patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) based on the time since HFmrEF/HFpEF diagnosis or the last hospitalization for heart failure, results of the suggest earlier initiation and optimization of dapagliflozin was associated with greater benefits on quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).¹

“SGLT2 inhibitors, are now a cornerstone in heart failure management, really across the spectrum of ejection fraction, explained lead investigator Ankeet Bhatt, MD, a research scientist at Kaiser Permanente Northern California and associate physician at Kaiser San Francisco Medical Center. “The challenge now is to ensure rapid, equitable implementation of this therapy, particularly in patients who've had in who have mildly reduced or preserved ejection fraction, in which there are more limited therapeutic options. The question becomes, when is the right time to initiate?”

To further explore the impact of prescription timing on outcomes and cost-effectiveness, Bhatt and investigators used a Markov cohort transition model for the UK setting and leveraged patient-level data from the pivotal DELIVER trial. A multicenter, parallel-group, event-driven, double-blind, randomized, controlled trial conducted at 353 centers in 20 countries, results of DELIVER indicated use of dapagliflozin was associated with an 18% relative risk reduction for the composite endpoint (HR, 0.82; 95% CI, 0.73 to 0.92]; P <.001). Further analysis demonstrated use of dapagliflozin was associated with a 21% reduction in risk of worsening heart failure (HR, 0.79; 95% CI, 0.69 to 0.91) and a 12% reduction in risk for cardiovascular mortality (HR, 0.88; 95% CI, 0.74 to 1.05).²

In the AHA 2024 analysis, patients were categorized by time since heart failure diagnosis and last hospitalization for heart failure event, including those with no prior hospitalizations for heart failure. The primary outcomes of interest for the analysis were incremental costs, QALYs, and ICERs. For the purpose of analysis, health state transitions were based on quartiles of the Kansas City Cardiomyopathy Questionnaire Total Symptom Scale, with adjustments for baseline characteristics and evolving health states.¹

Results indicated the lowest ICERs occurred in patients with the shortest time since heart failure diagnosis or last hospitalization for heart failure event. Across all subgroups, ICERs remained below the UK willingness-to-pay threshold of £20,000 per QALY gained, supporting dapagliflozin's cost-effectiveness.¹

For more on this study and the topic of early, rapid uptitration of GDMT in heart failure, check out our interview with Bhatt from the floor of AHA 2024.

Relevant disclosures for Bhatt include Sanofi and Novo Nordisk.

References:

1. Bhatt AS, De Boer RA, Booth D, Davis J, Chen J. Effect of Time Since Heart Failure Diagnosis or Hospitalization on the Cost-effectiveness of Dapagliflozin in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction. Paper presented at: American Heart Association Scientific Sessions 2024; November 15 - 18; Chicago, Il. Accessed November 16, 2024.
2. Campbell P. Dapagliflozin proves HFPEF benefit in deliver trial. HCP Live. August 27, 2022. Accessed April 7, 2024. https://www.hcplive.com/view/dapagliflozin-proves-hfpef-benefit-in-deliver-trial.