Cost-Effectiveness of Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction

Background: Empagliflozin is the first medication to demonstrate clinical benefit in patients with heart failure with preserved ejection fraction, but its cost-effectiveness is unknown. We aimed to evaluate the cost-effectiveness of adding empagliflozin to standard therapy in patients with heart failure with preserved ejection fraction. Methods: A Markov model from the perspective of the Australian health care system was constructed to compare empagliflozin plus standard care to standard care alone among a hypothetical cohort of patients with heart failure with preserved ejection fraction. Clinical probabilities were derived from The EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction). Costs and utilities were derived from published sources. The main outcome was the incremental cost-effectiveness ratio per quality-adjusted life-year gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty. Costs and benefits were discounted at 5% annually. Results: Over a lifetime, the addition of empagliflozin to standard care prevented 167 heart failure hospitalizations and 155 heart failure-related urgent care visits for every 1000 patients treated and increased mean quality-adjusted survival by 0.16 quality adjusted life-years per patient. Mean lifetime costs in the empagliflozin and standard care groups were AUD$63 218 and AUD$58 478 per patient, respectively. This resulted in an incremental cost-effectiveness ratio of AUD$29 202 per quality adjusted life-year gained. In probabilistic sensitivity analyses, empagliflozin was cost-effective in 85% of 10 000 Monte Carlo simulations at a willingness-to-pay threshold of AUD$50 000 per quality adjusted life-year gained. Conclusions: In patients with heart failure with preserved ejection fraction, adding empagliflozin to standard care is likely to be cost-effective when compared with standard care alone in the Australian health care setting.