A value-based analysis of the systematic use of dapagliflozin in patients with heart failure

Le résumé fourni par la source

Abstract Background and Purpose Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a cornerstone in the treatment of heart failure (HF) as these are effective and cost-effective. However, their impact on the balance between relevant patient outcomes and healthcare costs are not well known. This study is a theoretical model to estimate with a value-based analysis the impact of the systematic use of dapagliflozin in an unselected group of HF patients comparing with those of a real cohort. Methods HF patients meeting the inclusion criteria of the DAPA-HF and DELIVER trials, were identified from electronic health records of a university hospital (2015–2017). Clinical outcomes, resource utilization, and costs were retrospectively analyzed over a 1080-day follow-up using the Clinical Outcomes, HEalthcare REsource utilizatioN, and relaTed costs (COHERENT) model. Based on the meta-analysis of dapagliflozin RCTs, a 10% reduction in all-cause mortality and a 29% reduction in HF-related admissions would be expected. A simulation model was developed to estimate the hypothetical outcomes assuming dapagliflozin use from the first ED visit. A new cohort (simulated cohort) was re-built and outcomes recalculated assuming that the 10% of the patients with the lowest predicted death risk among those who died, and the 29% with the lowest predicted readmission risk would benefit with the treatment. The predictive models were developed using a logistic regression model for the mortality risk, and a zero-inflated Poisson regression for HF hospitalisations. Sensitivity analyses selecting these patients randomly were performed. Hospital-related costs were obtained from the full-costing system and recalculated based on expected outcome improvements. The economic impact of mortality reduction was assessed using the value of statistical life years (VSLY), following OECD recommendations and adjusted for HF-related quality of life. Medication costs were estimated assuming all patients received optimal doses of guideline-directed therapies. Results The cohort included 5245 patients (median age 81.0 [IQR 72.0–86.0]; 54.6% women), with 2054 deaths (39.2%) and 3110 (59.3%) readmissions. In the simulated cohort, deaths decreased to 1849, and HF admissions/readmissions were reduced to 2197 (Figure 1). Total costs over 1080 days were €84,249,150. Dapagliflozin treatment cost €7,101,772, leading to lower hospitalisation costs (€58,989,603 vs. €61,892,067) but slightly higher medication costs (€5,717,417 vs. €5,589,834) due to increased survival (Figure 2, top). The social value of mortality reduction was €11,217,429. Considering all, the patient journey cost was lower in the simulated cohort, representing a net saving of 6,663,950€ at the end of FU. Sensitivity analyses confirmed these results. The costs balance became positive approximately after 470 days of treatment (Figure 2, bottom). Conclusion The use of dapagliflozin in patients with HF may improve health care value in the long-term.Outcomes and costs using COHERENT model Estimated clinical and cost differences

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.