Rungroj Krittayaphong1, Unchalee Permsuwan2,3. 1. Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2. Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand. unchalee.permsuwan@gmail.com. 3. Center for Medical and Health Technology Assessment, Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand. unchalee.permsuwan@gmail.com.
Abstract
BACKGROUND: Clinical trials reported the benefit of empagliflozin when combined with standard treatment relative to cardiovascular death or heart failure (HF) hospitalization in patients with heart failure with reduced or preserved ejection fraction (HFrEF and HFpEF, respectively). We conducted a cost-utility analysis of combination empagliflozin and standard treatment (ST) versus ST alone in Thai HF patients with HFrEF or HFpEF. METHODS: A Markov model was employed to capture lifetime direct medical costs and outcomes from a healthcare system perspective. Two cohorts (HFrEF and HFpEF) with an average age of 60 years were enrolled. The clinical inputs were the results of the EMPEROR-Reduced and EMPEROR-Preserved studies, and a Thai database. Costs were gathered from published studies or from a Thai hospital database. Utilities were obtained from published studies. All costs and outcomes were discounted at a rate of 3% per annum. Incremental cost-effectiveness ratios (ICERs) were estimated, and sensitivity analyses were performed. RESULTS: In patients with HFrEF, add-on empagliflozin yielded a life-year gain of 0.26, and a quality-adjusted life-year (QALY) gain of 0.20 at an increased total cost of 409.82 USD compared to ST alone [ICER: 69,218 THB/QALY (2064.98 USD/QALY gained)]. Among HFpEF patients, add-on empagliflozin yielded a life-year gain of 0.07, and a QALY gain of 0.05 at an increased total cost of 622.49 USD compared to ST alone [ICER: 395,826 THB/QALY (11,809 USD/QALY gained)]. CONCLUSIONS: At the local Thai threshold of 4773.27 USD/QALY, empagliflozin is a cost-effective add-on treatment for patients with HFrEF, but not for patients with HFpEF.
BACKGROUND: Clinical trials reported the benefit of empagliflozin when combined with standard treatment relative to cardiovascular death or heart failure (HF) hospitalization in patients with heart failure with reduced or preserved ejection fraction (HFrEF and HFpEF, respectively). We conducted a cost-utility analysis of combination empagliflozin and standard treatment (ST) versus ST alone in Thai HF patients with HFrEF or HFpEF. METHODS: A Markov model was employed to capture lifetime direct medical costs and outcomes from a healthcare system perspective. Two cohorts (HFrEF and HFpEF) with an average age of 60 years were enrolled. The clinical inputs were the results of the EMPEROR-Reduced and EMPEROR-Preserved studies, and a Thai database. Costs were gathered from published studies or from a Thai hospital database. Utilities were obtained from published studies. All costs and outcomes were discounted at a rate of 3% per annum. Incremental cost-effectiveness ratios (ICERs) were estimated, and sensitivity analyses were performed. RESULTS: In patients with HFrEF, add-on empagliflozin yielded a life-year gain of 0.26, and a quality-adjusted life-year (QALY) gain of 0.20 at an increased total cost of 409.82 USD compared to ST alone [ICER: 69,218 THB/QALY (2064.98 USD/QALY gained)]. Among HFpEF patients, add-on empagliflozin yielded a life-year gain of 0.07, and a QALY gain of 0.05 at an increased total cost of 622.49 USD compared to ST alone [ICER: 395,826 THB/QALY (11,809 USD/QALY gained)]. CONCLUSIONS: At the local Thai threshold of 4773.27 USD/QALY, empagliflozin is a cost-effective add-on treatment for patients with HFrEF, but not for patients with HFpEF.