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Original Investigation
May 26, 2021

Cost-effectiveness of Dapagliflozin for Treatment of Patients With Heart Failure With Reduced Ejection Fraction

Author Affiliations
  • 1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
  • 2Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, The Freeman Spogli Institute, Department of Medicine, Stanford University, Stanford, California
  • 3St Luke’s Mid America Heart Institute, University of Missouri–Kansas City
  • 4Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA Cardiol. 2021;6(8):926-935. doi:10.1001/jamacardio.2021.1437
Key Points

Question  Is dapagliflozin cost-effective when added to standard of care for patients who have heart failure with reduced ejection fraction (HFrEF) with and without diabetes?

Findings  This economic evaluation used a Markov model based on the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure population and found dapagliflozin had an incremental cost-effectiveness ratio of $83 650 per quality-adjusted life-year gained, indicating intermediate value according to American College of Cardiology/American Heart Association benchmarks. The cost-effectiveness of dapagliflozin was similar for subgroups with and without diabetes and among those with more or less impaired health status due to heart failure.

Meaning  These findings suggest that dapagliflozin is cost-effective for patients with HFrEF; therefore, given evidence of clinical benefit and economic value, focus should be on increasing therapy rates among patients who have HFrEF with and without diabetes.


Importance  In the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial, dapagliflozin was shown to reduce cardiovascular mortality and hospitalizations due to heart failure while improving patient-reported health status. However, the cost-effectiveness of adding dapagliflozin therapy to standard of care (SOC) is unknown.

Objective  To estimate the cost-effectiveness of dapagliflozin therapy among patients with chronic heart failure with reduced ejection fraction (HFrEF).

Design, Setting, and Participants  This Markov cohort cost-effectiveness model used estimates of therapy effectiveness, transition probabilities, and utilities from the DAPA-HF trial and other published literature. Costs were derived from published sources. Patients with HFrEF included subgroups based on diabetes status and health status impairment due to heart failure. We compiled parameters from the literature including DAPA-HF, on which our model is based, and many other sources from December 2019 to February 27, 2021. We performed our analysis in February 2021.

Exposures  Dapagliflozin or SOC.

Main Outcomes and Measures  Hospitalizations for heart failure, life-years, quality-adjusted life-years (QALYs), costs, and the cost per QALY gained (incremental cost-effectiveness ratio).

Results  In the model, dapagliflozin therapy yielded a mean of 0.78 additional life-years and 0.46 additional QALYs compared with SOC at an incremental cost of $38 212, resulting in a cost per QALY gained of $83 650. The cost per QALY was similar for patients with or without diabetes and for patients with mild or moderate impairment of health status due to heart failure. The cost-effectiveness was most sensitive to estimates of the effect on mortality and duration of therapy effectiveness. If the cost of dapagliflozin decreased from $474 to $270 (43% decline), the cost per QALY gained would drop below $50 000.

Conclusions and Relevance  These findings suggest that dapagliflozin provides intermediate value compared with SOC, based on American College of Cardiology/American Heart Association benchmarks. Additional data regarding the magnitude of mortality reduction would improve the precision of cost-effectiveness estimates.

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