Cost-Effectiveness Evaluation of Add-on Empagliflozin in Patients With Heart Failure and a Reduced Ejection Fraction From the Healthcare System's Perspective in the Asia-Pacific Region

Chia-Te Liao; Chun-Ting Yang; Fang-Hsiu Kuo; Mei-Chuan Lee; Wei-Ting Chang; Hsin-Ju Tang; Yi-Ming Hua; Hung-Yu Chang; Zhih-Cherng Chen; Carol Strong; Huang-Tz Ou; Han Siong Toh

doi:10.3389/fcvm.2021.750381

Cost-Effectiveness Evaluation of Add-on Empagliflozin in Patients With Heart Failure and a Reduced Ejection Fraction From the Healthcare System's Perspective in the Asia-Pacific Region

Front Cardiovasc Med. 2021 Oct 29:8:750381. doi: 10.3389/fcvm.2021.750381. eCollection 2021.

Authors

Chia-Te Liao^{1

2

3}, Chun-Ting Yang⁴, Fang-Hsiu Kuo², Mei-Chuan Lee^{1

5}, Wei-Ting Chang^{2

6

7}, Hsin-Ju Tang⁸, Yi-Ming Hua⁵, Hung-Yu Chang^{9

10}, Zhih-Cherng Chen², Carol Strong¹, Huang-Tz Ou^{4

11}, Han Siong Toh^{6

12

13}

Affiliations

¹ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
³ Department of Electrical Engineer, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
⁴ Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan.
⁶ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
⁸ Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
⁹ Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁰ Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
¹¹ Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹² Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹³ Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.

Abstract

Background: EMPEROR-Reduced trial provides promising evidence on the efficacy of empagliflozin adding to the standard treatment in patients with heart failure and reduced ejection fraction (HFrEF). This study aimed to investigate the cost-effectiveness of add-on empagliflozin vs. standard therapy alone in HFrEF from the perspective of the Asia-Pacific healthcare systems. Methods: A Markov model was constructed to simulate HFrEF patients and to project the lifetime direct medical costs and quality-adjusted life years (QALY) of both therapies. Transitional probabilities were derived from the EMPEROR-Reduced trial. Country-specific costs and utilities were extracted from published resources. Incremental cost-effectiveness ratio (ICER) against willingness to pay (WTP) threshold was used to examine the cost-effectiveness. A series of sensitivity analyses was performed to ensure the robustness of the results. Results: The ICERs of add-on empagliflozin vs. standard therapy alone in HFrEF were US$20,508, US$24,046, US$8,846, US$53,791, US$21,543, and US$20,982 per QALY gained in Taiwan, Japan, South Korea, Singapore, Thailand, and Australia, respectively. Across these countries, the probabilities of being cost-effective for using add-on empagliflozin under the WTP threshold of 3-times country-specific gross domestic product per capita were 93.7% in Taiwan, 95.6% in Japan, 96.3% in South Korea, 94.2% Singapore, 51.9% in Thailand, and 95.9% in Australia. The probabilities were reduced when shortening the time horizon, assuming the same cardiovascular mortality for both treatments, and setting lower WTP thresholds. Conclusion: Adding empagliflozin to HFrEF treatment is expected to be a cost-effective option among the Asia-Pacific countries. The cost-effectiveness is influenced by the WTP thresholds of different countries.

Keywords: Asia-Pacific; SGLT2 inhibitor; cost-effectiveness; empagliflozin; heart failure with a reduced ejection fraction (HFrEF); systolic heart failure.