Medical therapy

Adding dapagliflozin to effective and cost-effective medical treatment in HFrEF

August 16, 2021

2 minute read


Disclosures: Isaza does not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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In a simulation model, adding dapagliflozin to guideline-directed medical treatment in HF patients with reduced ejection fraction improved long-term clinical outcomes while being cost-effective current in the United States.

“Scalable strategies to improve dapagliflozin absorption may improve long-term outcomes in heart failure patients with reduced ejection fraction,” Nicholas Isaza, MD, internal medicine resident at Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues wrote in Open JAMA Network.

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For the study, Isaza and colleagues tested the cost-effectiveness of adding the SGLT2 inhibitor dapagliflozin (Farxiga, AstraZeneca) to guideline-directed medical therapy for the treatment of HFrEF in patients with and without diabetes. Their economic evaluation used a Markov cohort model that compared dapagliflozin and guideline-compliant medical treatment with guideline-compliant medical treatment alone in a hypothetical cohort of US adults; this cohort had clinical characteristics comparable to those of the participants in the DAPA-HF trial.

Isaza and colleagues assumed an annual cost of $4,192 for dapagliflozin and analyzed data from September 2019 to January 2021. The primary outcome was the incremental lifetime cost-effectiveness ratio in 2020 US dollars per quality-adjusted life year gained.

The starting age of the simulated cohort was 66 years, 41.8% being diabetic at baseline. The median survival was 6.8 years in the guideline-directed medical treatment group.

The researchers predicted that dapagliflozin added 0.63 QALYs at an incremental lifetime cost of $42,800, resulting in an additional cost-effectiveness of $68,300 per QALY gained.

Additionally, dapagliflozin treatment was cost-effective in 94% of 10,000 probabilistic simulations, which suggested to the researchers that their results were robust across a wide range of estimates of key model parameters.

Additionally, diabetes status did not affect the results, although the results were sensitive to drug cost. The researchers attributed this observation to patients with diabetes receiving greater clinical benefit, given their initial increased risk of major adverse CV events, while they also accrued higher health care costs for each year. prolonged survival.

Although total and out-of-pocket costs have slowed the adoption of new CV therapies in recent years, the researchers noted three reasons that suggest the experience with SGLT2 inhibitors will be different: the US pharmaceutical market; #2, the availability of multiple SGLT2 inhibitors may allow payers to negotiate better prices in exchange for preferential placement on the formulary; and #3, recently proposed policy reforms would require payers to pass on at least some of the manufacturer’s rebates to patients.

“Collectively, these changes could significantly reduce total costs to payers and out-of-pocket costs to patients, and expand access to this cost-effective therapy,” they wrote.