Pharmacoeconomic Evaluation Of Empagliflozin In The Treatment Of Heart Failure With Reduced Ejection Fraction

ObjectiveIn this study,the principles and methods of pharmacoeconomics were used to conduct a pharmacoeconomics of empagliflozin in the treatment of heart failure with reduced ejection fraction(HFrEF)in China,and to provide evidence-based reference for clinical rational drug selection and medical and healthy decision-making.Methods(1)The clinical parameters came from the EMPEROR-Reduced study.First,the incidence of events in each health state of HFrEF patients was calculated,and then converted to the monthly transition probability between states according to the pharmacoeconomics formula.The cost only takes into account direct medical costs,including monthly empagliflozin expenses,monthly standard treatment expenses and single hospitalization costs due to deterioration of HFrEF.The data of health utility value come from the statistics of Park et al.and the quality-adjusted life years(QALYs)is used as the output index.(2)Establishment of Markov model:The Markov model was constructed by using TreeAgePro2019 software.According to the evolution and prognosis of the disease,two independent health states were established:stable heart failure and death,and a transitional state:hospitalization.The simulation time limit is set to 20 years,and the cycle is 1 month,with a total of 240 cycles.Since the average age of the selected patients in the EMPEROR-Reduced study was about 67 years,the simulated termination age was 86 years old.(3)Sensitivity analysis:① Single factor sensitivity analysis:the influence of model parameters on the results of cost-effectiveness analysis was analyzed,and the results were expressed by tornado diagram.②Probability sensitivity analysis:a total of 1000 simulations were conducted by Monte Carlo simulation,and 1000 Markov cohort were obtained.The results were expressed by incremental cost-effectiveness ratio(ICER)scatter plot and cost-effectiveness acceptability curve.(4)Scenario analysis:The cost of empagliflozin,the single hospitalization cost of HFrEF and the simulated time limit were analyzed.Results(1)Cost-effectiveness analysis:The ICER was $3 842.20/QALY,that is,the cost of each additional QALY of the empagliflozin group was $3 842.20 more than that of the standard treatment group,which was less than China’s 1 time the GDP per capita in 2021($11 981).(2)Sensitivity analysis:The results of single factor sensitivity analysis showed that the steady state mortality of the two groups had the greatest influence on the ICER.The results of probability sensitivity analysis show that when the willingness to pay(WTP)threshold is China’s 1 time the GDP per capita in 2021($11 981),the probability of empagliflozin group with cost-effectiveness advantage was 85.8%;when the WTP was 3 times GDP per capita in 2021($35 943),the probability of empagliflozin group with cost-effectiveness advantage was 91.6%.(3)Scenario analysis:With the reduction of empagliflozin cost,the increase of HFrEF hospitalization cost and the extension of simulation time,ICER will decrease accordingly,that is,the cost-effectiveness advantage of empagliflozin is more obvious.ConclusionsBased on the results of EMPEROR-Reduced study and published literature data,this study evaluated the economy of empagliflozin in the treatment of HFrEF.It is proved that the standard treatment combined with empagliflozin regimen has more cost-effectiveness advantages than the standard treatment alone in the treatment of HFrEF.The stability of the model is verified by the results of single factor sensitivity analysis and probability sensitivity analysis.