Cost-utility analysis of dapagliflozin for the treatment of symptomatic chronic heart failure in Spain

Methods: A Markov model was designed to simulate the progression of chronic HF over a lifetime horizon using pooled data from the DAPA-HF and DELIVER trials. Disease progression was captured by transitions between health states, defined by the Kansas City Cardiomyopathy Questionnaire Total Symptom Score. Transient events of hospitalization for HF (HHF), urgent HF visits (UHFV) and cardiovascular (CV) and non-CV death were included. The analysis was conducted from the Spanish National Health System perspective. The results were expressed as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to assess the robustness of the results.

Results: Dapagliflozin + SoC showed an increase in effectiveness (0.31 QALY) and total cost per patient (€1,441) compared to SoC, yielding an incremental cost-utility ratio of €4,611/QALY. Dapagliflozin reduced the incidence of HHF by 136.4 events (752.2 vs. 886.6), UHFV by 38.8 (217.6 vs. 254.4) and CV death by 23.0 (505.8 vs. 528.8) for every 1,000 patients. Dapagliflozin + SoC was cost-effective compared to SoC in 99.9% of iterations at a willingness-to-pay (WTP) threshold of €25,000/QALY.

Conclusions: The analysis shows that dapagliflozin, as add-on therapy to SoC, would be a cost-effective option compared to SoC for the treatment of adult patients with symptomatic chronic HF in Spain at a WTP of €25,000/QALY.