Cost-Effectiveness of Empagliflozin in Combination with Standard Care versus Standard Care Only in the Treatment of Heart Failure Patients in Finland.

Sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin has recently been shown to improve the outcomes of heart failure (HF) patients regardless of patient's left ventricular ejection fraction by reducing the combined risk of cardiovascular death or hospitalization for worsening HF. The aim of this study was to assess the cost-effectiveness of adding empagliflozin to the standard care (SC) in comparison to SC only in the treatment of HF in Finland. The assessment was performed in the cost-utility framework using two Markov cohort state-transition models, one for HF with reduced ejection fraction (HFrEF) and one for HF with preserved ejection fraction (HFpEF). The models have been primarily developed based on the EMPEROR-Reduced and EMPEROR-Preserved trials which informed the modelled patient characteristics, efficacy of treatments in terms of associated risks for heart failure hospitalizations, cardiovascular (CV) and non-CV death, treatment related adverse events (AE), and state- and event-specific health-related quality of life weights (EQ-5D). Direct health care costs were estimated from Finnish published references. Cost-effectiveness was assessed from health care payer perspective based on incremental cost-effectiveness ratio (ICER; cost per quality adjusted life-year [QALY] gained) and probability of cost-effectiveness (at willingness-to-pay [WTP] of 35,000 euros/QALY). The ICER was reported as the weighted (HFrEF, 43.5%; HFpEF, 56.5%) average result of the two models. Empagliflozin + SC treatment increased the average quality-adjusted life-expectancy, and treatment costs of HF patients by 0.15 QALYs and 1,594 euros, respectively, when compared to SC. An additional QALY with empagliflozin was thus gained at a cost of 10,621 euros. The probability of empagliflozin + SC being cost-effective compared to placebo + SC was 77.6% and 83.5% with WTP of 35,000 and 100,000 euros/QALY, respectively. Empagliflozin is a cost-effective treatment for patients with HF in the Finnish health care setting.

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© 2023 Hallinen et al.

Déclaration de conflit d'intérêts

TH and ES are partners and employees of ESiOR Oy; SK is an employee of ESiOR Oy, which was commissioned by Boehringer Ingelheim Ky to perform this study. In these salaried positions, TH, ES and SK work with a variety of companies and are explicitly precluded from accepting any payment or honoraria directly from Boehringer Ingelheim Ky. ESiOR has carried out commissioned studies and health-economic analyses for several other pharmaceutical companies, food industry companies, device companies, research groups, health care organizations, and hospitals. VPH has received a consulting fee from Boehringer Ingelheim Ky, Finland. Mari Pesonen is an employee of Boehringer Ingelheim Finland Ky. The authors report no other conflicts of interest in this work.