Added SGLT2 Inhibitor Therapy of Intermediate/Low Value in Heart Failure With Preserved Ejection Fraction 

Adding a sodium-glucose cotransporter-2 (SGLT2) inhibitor to standard care in US adults with heart failure with preserved ejection fraction is of intermediate or low economic value at 2022 drug prices, according to a study published in JAMA Cardiology.

“Efforts to expand access to SGLT2 inhibitors for individuals with heart failure with preserved ejection fraction should be coupled with efforts to lower the cost of SGLT2 inhibitor therapy,” wrote first author Laura P. Cohen, MD, MPP, of Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and Columbia University Medical Center, New York, New York, and coauthors.

The study investigated the lifetime cost-effectiveness of standard therapy plus an SGLT2 inhibitor to reduce the risk of worsening heart failure or cardiovascular mortality, compared with standard therapy, in patients with heart failure with preserved ejection fraction. A Markov model used results from the Empagliflozin in Heart Failure With a Preserved Ejection Fraction (EMPEROR-Preserved) and Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction (DELIVER) trials to simulate monthly outcomes.

According to the findings, adding an SGLT2 inhibitor to standard therapy increased quality-adjusted survival by 0.19 quality-adjusted life-years (QALYs) at an added cost of $26,300. 

“The resulting incremental cost-effectiveness ratio (ICER) was $141,200 per QALY gained,” researchers reported, “with 59.1% of 1000 probabilistic iterations indicating intermediate value and 40.9% indicating low value.” 

SGLT2 inhibitor costs, as well as the effect of an added SGLT2 inhibitor on cardiovascular death, had the most impact on ICER. If SGLT2 inhibitor therapy was assumed to have no effect on mortality, the ICER increased to $373,400 per QALY gained. According to the American College of Cardiology/American Heart Association value framework, ICERs of $150,000 or more are considered of low value.

“An SGLT2 inhibitor would not be cost-effective if there is no mortality benefit,” researchers advised.

Reference:
Cohen LP, Isaza N, Hernandez I, et al. Cost-effectiveness of sodium-glucose cotransporter-2 inhibitors for the treatment of heart failure with preserved ejection fraction. JAMA Cardiol. Published online March 4, 2023. doi:10.1001/jamacardio.2023.0077