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Cost-Effectiveness of Dapagliflozin in Heart Failure with Preserved or Mildly Reduced Ejection Fraction: the DELIVER Trial

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Abstract

Purpose

The DELIVER trial demonstrated the efficacy of dapagliflozin in reducing primary endpoint (cardiovascular (CV) mortality or worsening heart failure) for heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). This study assessed the economic and clinical effects of incorporating dapagliflozin into a standard treatment regimen for HFpEF and HFmrEF cases in China.

Methods

A multistate Markov model was used to assess the clinical and economic effects of adding dapagliflozin to the usual treatment regimen for HFpEF and HFmrEF. A log-logistic formula was used to represent the cumulative incidence of hospitalization, readmission, and CV mortality. A 5% annual discount was applied to all costs. The health outcome was the incremental cost-effectiveness ratio (ICER), measured using quality-adjusted life years (QALYs) and life years (LYs). The findings were examined using sensitivity and scenario analyses to assess robustness.

Results

In the HFpEF or HFmrEF population, the 11.2-year incremental QALYs was 0.15 and LYs was 0.2, yielding an ICER of $10,615.87 per QALY and $7,763.08 per LY. These ICER values are lower than China’s per capita gross domestic product (GDP) of $12,752 in 2022. The one-way sensitivity analysis revealed that non-hospital CV death was the most influential parameter. Furthermore, there was a 68% chance that dapagliflozin was cost-effective as an additional treatment, given a willingness-to-pay limit of three times the GDP ($38,256).

Conclusions

Dapagliflozin adjunctive therapy was cost-effective in patients with HFpEF or HFmrEF from the perspective of Chinese national insurance.

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Data Availability

All data generated or analyzed during this study were included in the article.

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Acknowledgements

We would like to thank Editage for English language editing.

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Author notes

  1. Lu Lin and Qiu-ping Xiu contributed equally to the work.

Authors and Affiliations

  1. Department of Clinical Trial, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Lu Lin & Qiu-ping Xiu

  2. Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Fei Liu

  3. Department of Pharmacy, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, No. 2999 Jinshan Road, Huli District, Xiamen, 361000, Fujian, China

    Hou-jing Zhang & Yi-feng Chen

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  1. Lu Lin
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Contributions

Model construction, data collection, and analysis were performed by Lu Lin, Yifeng Chen, Fei Liu, and Houjing Zhang. Lu Lin and Yifeng Chen drafted and wrote the manuscript. Professional advice on disease development and model path was provided by Qiuping Xiu. All authors actively participated in the subsequent critical revision. All authors contributed to this article, approved the final version for publication, and agreed to be accountable for all aspects of the work.

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Correspondence to Yi-feng Chen.

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Lin, L., Xiu, Qp., Liu, F. et al. Cost-Effectiveness of Dapagliflozin in Heart Failure with Preserved or Mildly Reduced Ejection Fraction: the DELIVER Trial. Cardiovasc Drugs Ther (2023). https://doi.org/10.1007/s10557-023-07515-3

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