Heart failure (HF) represents a major global health and economic burden with still unacceptably high morbidity and mortality rates. In recent decades, novel therapeutic opportunities with a significant impact on HF outcomes have been introduced in addition to angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and mineralocorticoid receptor antagonists. These include drugs such as ivabradine, sacubitril–valsartan, and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. The availability of an extremely large pharmacological armamentarium to face this chronic global disease highlights the importance of assessing cost effectiveness to promote sustainable healthcare. In light of the recent approval of SGLT-2 inhibitors for the treatment of HF with reduced ejection fraction, including in individuals without type 2 diabetes mellitus, the aim of this review was to provide an updated comparative evaluation of the efficacy and cost effectiveness of different pharmacological treatments for the prevention (stage A) and treatment of asymptomatic (stage B) and symptomatic (stages C–D) left ventricular dysfunction.

心力衰竭 (HF) 是全球主要的健康和经济负担，其发病率和死亡率仍然高得令人无法接受。近几十年来，除了血管紧张素转换酶 (ACE) 抑制剂、β 受体阻滞剂和盐皮质激素受体拮抗剂外，还引入了对 HF 结局产生重大影响的新治疗机会。这些药物包括伊伐布雷定、沙库巴曲缬沙坦和钠-葡萄糖协同转运蛋白 2 (SGLT-2) 抑制剂等药物。面对这种慢性全球疾病的超大型药理设备的可用性凸显了评估成本效益以促进可持续医疗保健的重要性。鉴于最近批准 SGLT-2 抑制剂用于治疗射血分数降低的 HF，包括在没有 2 型糖尿病的个体中，