Background

Comorbid heart failure with reduced ejection fraction (HFrEF) and type 2 diabetes mellitus (DM) is associated with a very high risk of HF events. Sacubitril–valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), and dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, improve HF outcomes in these patients, but their comparative value for money in this patient population has not yet been determined.

Objective

We aimed to compare the cost needed to treat (CNT) to avoid an HF event with each drug.

Methods

CNT was estimated by multiplying the annualized number needed to treat (NNT) to prevent one HF event by the annual cost of each therapy. HF events were defined as the first event of hospitalization for HF or cardiovascular mortality. Drug efficacy data were extracted from published secondary analyses of patients with DM in the DAPA-HF and PARADIGM-HF trials. Drug costs were estimated as 75% of the 2021 US National Average Drug Acquisition Cost listing. Sensitivity analysis was performed on parameters that may have affected the CNT.

Results

The annualized NNT was 24 (95% confidence interval [CI] 16–54) for dapagliflozin and 57 (95% CI 31–433) for the ARNI. At an annual cost of $US4523 and 5099, respectively, the CNT was $US108,563 (95% CI 72,375–244,267) for dapagliflozin and $US290,671 (95% CI 158,084–2,208,079) for the ARNI.

Conclusions

Dapagliflozin seems to offer greater value for money than the ARNI for patients with HFrEF and DM. Our results provide support for contemporary guidelines advocating the use of dapagliflozin in these patients.

中文翻译：

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Dapagliflozin 与 Sacubitril–Valsartan 改善射血分数降低和糖尿病患者的预后

背景

合并射血分数降低的心力衰竭 (HFrEF) 和 2 型糖尿病 (DM) 与非常高的 HF 事件风险相关。Sacubitril-valsartan 是一种血管紧张素受体脑啡肽酶抑制剂 (ARNI) 和 dapagliflozin 是一种钠-葡萄糖协同转运蛋白 2 抑制剂，可改善这些患者的 HF 结局，但尚未确定它们在该患者群体中的相对性价比。

客观的

我们的目的是比较每种药物治疗所需的成本 (CNT) 以避免心衰事件。

方法

CNT 的估算方法是将预防一次 HF 事件所需的年度治疗次数 (NNT) 乘以每种治疗的年度费用。HF 事件被定义为首次因 HF 或心血管死亡而住院的事件。药物疗效数据来自 DAPA-HF 和 PARADIGM-HF 试验中已发表的对 DM 患者的二次分析。药品成本估计占 2021 年美国全国平均药品采购成本清单的 75%。对可能影响 CNT 的参数进行了敏感性分析。

结果

达格列净的年化 NNT 为 24（95% 置信区间 [CI] 16-54），ARNI 的年化 NNT 为 57（95% CI 31-433）。每年成本分别为 4523 美元和 5099 美元，达格列净的 CNT 为 108,563 美元（95% CI 72,375–244,267），ARNI 为 290,671 美元（95% CI 158,084–2,208,079）。

结论

对于 HFrEF 和 DM 患者，Dapagliflozin 似乎比 ARNI 更物有所值。我们的结果为提倡在这些患者中使用达格列净的当代指南提供了支持。