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. 2023 Dec;24(9):1441-1454.
doi: 10.1007/s10198-022-01555-6. Epub 2022 Dec 4.

A European multinational cost-effectiveness analysis of empagliflozin in heart failure with reduced ejection fraction

Ali Tafazzoli  1 , Odette S Reifsnider  2 , Leana Bellanca  3 , Jack Ishak  1 , Marc Carrasco  4 , Pal Rakonczai  5 , Matthew Stargardter  1 , Stephan Linden  6
Affiliations

A European multinational cost-effectiveness analysis of empagliflozin in heart failure with reduced ejection fraction

Ali Tafazzoli et al. Eur J Health Econ. 2023 Dec.

Abstract

Purpose: This research examined the cost-effectiveness of adding empagliflozin to standard of care (SoC) compared with SoC alone for treatment of heart failure with reduced ejection fraction (HFrEF) from the perspective of healthcare payers in the United Kingdom (UK), Spain and France.

Methods: A lifetime Markov cohort model was developed to simulate patients' progression through health states based on Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. The model predicted risk of death, hospitalisation for worsening heart failure (HHF), treatment-related adverse events, and treatment discontinuation each monthly cycle. Clinical inputs and utilities were derived from EMPEROR-Reduced trial data, supplemented by published literature and national costing databases. Costs (2021 pound sterling/euro) and quality-adjusted life-years (QALYs) were discounted annually for the UK (3.5%), Spain (3.0%) and France (2.5%).

Results: In the UK, Spain and France, empagliflozin plus SoC yielded additional QALYs (0.19, 0.23 and 0.21) at higher cost (£1185, €1770 and €1183 per patient) than SoC alone, yielding incremental cost-effectiveness ratios of £6152/QALY, €7736/QALY and €5511/QALY, respectively. Reduced HHF incidence provided most cost offsets for empagliflozin plus SoC. Similar results were obtained for a range of subgroups and sensitivity analyses. Probabilistic sensitivity results indicated empagliflozin plus SoC remained cost-effective vs. SoC at willingness-to-pay thresholds of £20,000/QALY, €20,000/QALY and €30,000/QALY in 79.6%, 75.5% and 97.3% of model runs for the UK, Spain and France, respectively.

Conclusions: Empagliflozin added to SoC leads to health benefits for patients with HFrEF and is a cost-effective treatment option for payers in multiple European countries (UK, Spain, France).

Keywords: Cost-effectiveness; Empagliflozin; Heart failure; Hospitalisation; Reduced ejection fraction; Sodium–glucose cotransporter-2 inhibitor.

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Conflict of interest statement

Stephan Linden, Leana Bellanca and Marc Carrasco are employees of Boehringer Ingelheim. Odette S. Reifsnider, Jack Ishak, Pal Rakonczai and Matthew Stargardter are employees of Evidera, a healthcare research firm that provides consulting and other research services to the biopharmaceutical and medical device industry, while Ali Tafazzoli was employed by Evidera during the conduct of this study and creation of this article. In these salaried positions, they work with a variety of companies and are explicitly precluded from accepting any payment or honoraria directly from those companies for services rendered. Evidera received payment from Boehringer Ingelheim for collaboration on this project and article.

Figures

Fig. 1
Fig. 1
Model diagram. HF heart failure, KCCQ-CSS Kansas City Cardiomyopathy Questionnaire Clinical Summary Score
Fig. 2
Fig. 2
Deterministic sensitivity analyses (top 10 scenarios). CV cardiovascular, HHF hospitalisation for worsening heart failure, ICER incremental cost-effectiveness ratio, KCCQ-CSS Kansas City Cardiomyopathy Questionnaire Clinical Summary Score, QALY quality-adjusted life-year, UK United Kingdom
Fig. 3
Fig. 3
Incremental cost-effectiveness scatterplots. QALY quality-adjusted life-year, UK United Kingdom
See this image and copyright information in PMC

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