Adding dapagliflozin to medical therapy efficacious, cost-effective in HFrEF
Click Here to Manage Email Alerts
In a simulation model, the addition of dapagliflozin to guideline-directed medical therapy in patients with HF with reduced ejection fraction improved long-term clinical outcomes while proving cost-effective at current U.S. prices.
“Scalable strategies for improving uptake of dapagliflozin may improve long-term outcomes in patients with heart failure with reduced ejection fraction,” Nicolas Isaza, MD, internal medicine resident at Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues wrote in JAMA Network Open.
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-directed medical therapy with guideline-directed medical therapy alone in a hypothetical cohort of U.S. adults; this cohort had comparable clinical characteristics with participants from 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 main outcome measure was lifetime incremental cost-effectiveness ratio in 2020 U.S. dollars per quality-adjusted life-year gained.
The starting age for the simulated cohort was 66 years, with 41.8% having diabetes at baseline. Median survival was 6.8 years in the guideline-directed medical therapy group.
Researchers projected that dapagliflozin added 0.63 QALYs at an incremental lifetime cost of $42,800, resulting in an incremental cost-effectiveness ratio of $68,300 per QALY gained.
Additionally, dapagliflozin therapy was cost-effective in 94% of 10,000 probabilistic simulations, which suggested to researchers that their findings were robust across a wide range of estimates of key model parameters.
Moreover, diabetes status did not impact the outcomes, although the results were sensitive to drug cost. The researchers attributed this observation to patients with diabetes receiving a larger clinical benefit, given their increased baseline risk for major adverse CV events, while they also accrued higher health care costs for every year of prolonged survival.
Although total and out-of-pocket costs have slowed uptake of novel CV therapies in recent years, the researchers noted three reasons that suggest the experience with SGLT2 inhibitors will be different: No. 1, diabetes therapies receive some of the largest manufacturer discounts in the U.S. pharmaceutical market; No. 2, the availability of several SGLT2 inhibitors may allow payers to negotiate better prices in return for preferential formulary placement; and No. 3, recently proposed policy reforms would require payers to pass on at least some of the manufacturer discounts to patients.
“Collectively, these changes could substantially lower total costs for payers and out-of-pocket costs for patients, and expand access to this cost-effective therapy,” they wrote.
Collapse
Read more about
Click Here to Manage Email Alerts