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Effect of Dapagliflozin Versus Empagliflozin on Cardiovascular Death in Patients with Heart Failure Across the Spectrum of Ejection Fraction: Cost per Outcome Analysis

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Abstract

Background

Dapagliflozin and empagliflozin have shown clinical benefits in patients with heart failure (HF). Their comparative monetary value remains undetermined, and we therefore sought to compare the cost-per-outcome implications of utilizing dapagliflozin versus empagliflozin to prevent cardiovascular death (CVD) in patients with HF across the spectrum of ejection fraction.

Methods

We estimated the cost needed to treat (CNT) to prevent one CVD with either dapagliflozin or empagliflozin. CNT was estimated by multiplying the annualized number needed to treat (aNNT) by the annual cost of therapy. The aNNTs were calculated based on data from the DAPA-HF and DELIVER trials for dapagliflozin, and the EMPEROR-Reduced and EMPEROR-Preserved trials for empagliflozin. Drug costs were calculated as 75% of the 2022 US National Average Drug Acquisition Cost.

Results

The aNNT to prevent one event of CVD was 110 (95% confidence interval [CI] 58–∞) for dapagliflozin in a pooled analysis of DAPA-HF and DELIVER versus 204 (95% CI 71–∞) for empagliflozin in a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials. The annual costs of therapy were $4807 and $4992, respectively. The corresponding CNTs were $528,770 (95% CI $278,806–∞) for dapagliflozin and $1,018,368 (95% CI $354,432–∞) for empagliflozin. This remained consistent in Europe, using the price estimates in Germany, with CNT (€77,490 for dapagliflozin and €143,708 for empagliflozin).

Conclusion

In incorporating data from all four outcomes trials of sodium-glucose cotransporter 2 inhibitors, dapagliflozin provides better monetary value for preventing CVD events in patients with HF across the spectrum of ejection fraction.

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Acknowledgments

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Author notes

  1. Hilmi Alnsasra and Gal Tsaban contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Soroka University Medical Center, Rager Av., POB 84101, Beersheva, Israel

    Hilmi Alnsasra, Gal Tsaban & Jean Marc Weinstein

  2. Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel

    Hilmi Alnsasra, Gal Tsaban, Adam Solomon & Jean Marc Weinstein

  3. Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA

    Fouad Khalil

  4. Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel

    Enis Aboalhasan & Ronen Arbel

  5. Diabetes Clinic, Central District, Maccabi Healthcare Services, Tel Aviv, Israel

    Joseph Azuri

  6. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Joseph Azuri

  7. Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel-Aviv, Israel

    Ariel Hammerman

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  1. Hilmi Alnsasra
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Correspondence to Hilmi Alnsasra.

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No external funding was used in the preparation of this manuscript.

Conflicts of Interest

Hilmi Alnsasra, Gal Tsaban, Adam Solomon, Fouad Khalil, Enis Aboalhasan, Jean Marc Weinstein, Joseph Azuri, Ariel Hammerman, and Ronen Arbel declare that they have no conflicts of interest.

Data Availability Statement

Data sharing is not applicable to this article as no datasets were generated and/or analyzed during the current study.

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Authors’ contributions

HA, GT, FK, JMW, JA, AH: Writing – reviewing and editing.AS: Writing – original draft, reviewing and editing. EA: Data analysis. RA: Supervision, conceptualization.

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Alnsasra, H., Tsaban, G., Solomon, A. et al. Effect of Dapagliflozin Versus Empagliflozin on Cardiovascular Death in Patients with Heart Failure Across the Spectrum of Ejection Fraction: Cost per Outcome Analysis. Am J Cardiovasc Drugs 23, 323–328 (2023). https://doi.org/10.1007/s40256-023-00578-5

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