Cost‑effectiveness of add‑on dapagliflozin for heart failure with reduced ejection fraction in patients without diabetes in Qatar.

Background

Few studies revealed that adding dapagliflozin to standard of care (SoC) among patients with heart failure with reduced ejection fraction (HFrEF) is cost-effective irrespective of diabetes status. However, it remains unclear whether dapagliflozin is cost-effective among patients with HFrEF and without type 2 diabetes mellitus (T2DM) at baseline. It is crucial to allocate resources efficiently and aid policy makers in prioritizing interventions to treat HFrEF. We aimed to evaluate the cost-effectiveness of dapagliflozin added to SoC versus SoC in HFrEF and without T2DM patients from the Qatari healthcare perspective.

Methods

A Markov model was developed to evaluate the cost-effectiveness of adding dapagliflozin to SoC based on findings of Petrie et al., 2020. The model included four health states: ‘alive with no event’, ‘urgent visit for heart failure’, ‘worsened with hospitalization for heart failure’, and ‘dead’ (Figure 1). The model considered 1,000 hypothetical HFrEF and without T2DM patients using 3-month cycles over a lifetime horizon. The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (QALY) and years of life lived (YLL). Utility and costs data were obtained from published sources. Sensitivity analyses were carried out to confirm robustness of conclusions.

Results

Adding dapagliflozin was estimated to dominate SoC alone, resulting in 0.6 QALY and 0.8 YLL, at a cost saving of QAR 516 compared with SoC alone (Table 1). This was associated with negative ICER (i.e. cost saving) of QAR -817 per QALYs gained, and QAR -613 per YLL. This was maintained in 50% of the simulated cases against QALYs gained and YLL in the sensitivity analysis. The transition probabilities of cardiovascular death in both groups drove the differential QALYs and YLL outcomes the most.

Conclusions

The addition of dapagliflozin to SoC is likely to be a cost saving therapy for non?T2DM patients with HFrEF in Qatar.