Effect of Dapagliflozin Versus Empagliflozin on Cardiovascular Death in Patients with Heart Failure Across the Spectrum of Ejection Fraction: Cost per Outcome Analysis

Hilmi Alnsasra, Gal Tsaban, Adam Solomon, Fouad Khalil, Enis Aboalhasan, Jean Marc Weinstein, Joseph Azuri, Ariel Hammerman, Ronen Arbel

    Research output: Contribution to journalArticlepeer-review

    2 Scopus citations

    Abstract

    Background: Dapagliflozin and empagliflozin have shown clinical benefits in patients with heart failure (HF). Their comparative monetary value remains undetermined, and we therefore sought to compare the cost-per-outcome implications of utilizing dapagliflozin versus empagliflozin to prevent cardiovascular death (CVD) in patients with HF across the spectrum of ejection fraction. Methods: We estimated the cost needed to treat (CNT) to prevent one CVD with either dapagliflozin or empagliflozin. CNT was estimated by multiplying the annualized number needed to treat (aNNT) by the annual cost of therapy. The aNNTs were calculated based on data from the DAPA-HF and DELIVER trials for dapagliflozin, and the EMPEROR-Reduced and EMPEROR-Preserved trials for empagliflozin. Drug costs were calculated as 75% of the 2022 US National Average Drug Acquisition Cost. Results: The aNNT to prevent one event of CVD was 110 (95% confidence interval [CI] 58–∞) for dapagliflozin in a pooled analysis of DAPA-HF and DELIVER versus 204 (95% CI 71–∞) for empagliflozin in a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials. The annual costs of therapy were $4807 and $4992, respectively. The corresponding CNTs were $528,770 (95% CI $278,806–∞) for dapagliflozin and $1,018,368 (95% CI $354,432–∞) for empagliflozin. This remained consistent in Europe, using the price estimates in Germany, with CNT (€77,490 for dapagliflozin and €143,708 for empagliflozin). Conclusion: In incorporating data from all four outcomes trials of sodium-glucose cotransporter 2 inhibitors, dapagliflozin provides better monetary value for preventing CVD events in patients with HF across the spectrum of ejection fraction.

    Original languageEnglish
    Pages (from-to)323-328
    Number of pages6
    JournalAmerican Journal of Cardiovascular Drugs
    Volume23
    Issue number3
    DOIs
    StatePublished - 1 May 2023

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Pharmacology (medical)

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