Importance In the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial, dapagliflozin was shown to reduce cardiovascular mortality and hospitalizations due to heart failure while improving patient-reported health status. However, the cost-effectiveness of adding dapagliflozin therapy to standard of care (SOC) is unknown.

Objective To estimate the cost-effectiveness of dapagliflozin therapy among patients with chronic heart failure with reduced ejection fraction (HFrEF).

Design, Setting, and Participants This Markov cohort cost-effectiveness model used estimates of therapy effectiveness, transition probabilities, and utilities from the DAPA-HF trial and other published literature. Costs were derived from published sources. Patients with HFrEF included subgroups based on diabetes status and health status impairment due to heart failure. We compiled parameters from the literature including DAPA-HF, on which our model is based, and many other sources from December 2019 to February 27, 2021. We performed our analysis in February 2021.

Exposures Dapagliflozin or SOC.

Main Outcomes and Measures Hospitalizations for heart failure, life-years, quality-adjusted life-years (QALYs), costs, and the cost per QALY gained (incremental cost-effectiveness ratio).

Results In the model, dapagliflozin therapy yielded a mean of 0.78 additional life-years and 0.46 additional QALYs compared with SOC at an incremental cost of $38 212, resulting in a cost per QALY gained of $83 650. The cost per QALY was similar for patients with or without diabetes and for patients with mild or moderate impairment of health status due to heart failure. The cost-effectiveness was most sensitive to estimates of the effect on mortality and duration of therapy effectiveness. If the cost of dapagliflozin decreased from $474 to $270 (43% decline), the cost per QALY gained would drop below $50 000.

Conclusions and Relevance These findings suggest that dapagliflozin provides intermediate value compared with SOC, based on American College of Cardiology/American Heart Association benchmarks. Additional data regarding the magnitude of mortality reduction would improve the precision of cost-effectiveness estimates.

重要性 在 Dapagliflozin 和预防心力衰竭不良结果 (DAPA-HF) 试验中，dapagliflozin 被证明可以降低心血管死亡率和心力衰竭导致的住院率，同时改善患者报告的健康状况。然而，在标准护理 (SOC) 中添加达格列净治疗的成本效益尚不清楚。

目的 评估达格列净治疗射血分数降低的慢性心力衰竭（HFrEF）患者的成本效益。

设计、设置和参与者 该马尔可夫队列成本效益模型使用了来自 DAPA-HF 试验和其他已发表文献的治疗效果、转换概率和效用的估计值。成本来自公开的来源。HFrEF 患者包括基于糖尿病状态和心力衰竭导致的健康状况损害的亚组。我们从 2019 年 12 月至 2021 年 2 月 27 日的文献中汇编了参数，包括我们模型所基于的 DAPA-HF 和许多其他来源。我们在 2021 年 2 月进行了分析。

暴露 Dapagliflozin 或 SOC。

主要结果和措施 心力衰竭住院、生命年、质量调整生命年 (QALYs)、成本和每个 QALY 获得的成本（增量成本效益比）。

结果 在该模型中，与 SOC 相比，达格列净治疗平均延长了 0.78 个生命年和 0.46 个 QALY，增量成本为 38 212 美元，导致每个 QALY 的成本增加了 83 650 美元。患者的每个 QALY 成本相似患有或不患有糖尿病，以及因心力衰竭而导致健康状况轻度或中度受损的患者。成本效益对估计对死亡率和治疗有效性持续时间的影响最为敏感。如果 dapagliflozin 的成本从 474 美元降至 270 美元（下降 43%），则每 QALY 获得的成本将降至 50 000 美元以下。

结论和相关性 根据美国心脏病学会/美国心脏协会的基准，这些研究结果表明，与 SOC 相比，达格列净提供了中等价值。有关死亡率降低幅度的额外数据将提高成本效益估计的准确性。