Time-varying cost-effectiveness analysis of sodium-glucose cotransporter-2 inhibitors in Chinese patients with heart failure and reduced ejection fraction: a microsimulation of real-world population

Xinyu Zou ¹ Xingchen He ¹ Qingyang Shi ^1,2 Si Wang ³ Nan Li ⁴ Yiling Zhou ^1,2 Ming Hu ⁵ Li Luo ⁶ Yiwen Shen ⁷ Ye Zhu ³ Chim Lang ⁸ Zhiming Zhu ⁹ Haoming Tian ¹ Sheyu Li ^1*

• ¹ Department of Endocrinology and Metabolism, MAGIC China Centre, West China Hospital of Sichuan University, Chengdu, China
• ² Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands
• ³ Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
• ⁴ Department of Informatics, West China Hospital of Sichuan University, Chengdu, China
• ⁵ West China School of Pharmacy, Sichuan University, Chengdu, Sichuan Province, China
• ⁶ Business School, Sichuan University, Chengdu, China
• ⁷ School of Business and Management, The Hong Kong University of Science and Technology, Hong Kong, China
• ⁸ Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
• ⁹ Department of Hypertension and Endocrinology, Centre for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing, China

Objective: Sodium-glucose cotransporter-2 (SGLT2) inhibitors showed time-varying effects in heart failure and reduced ejection fraction (HFrEF) but corresponding cost-effectiveness in different timeframes was unclear. This study estimated time-varying cost-effectiveness of SGLT2 inhibitors in HFrEF from the perspective of Chinese healthcare system.: Based on real-world individual patient data, we constructed a two-year microsimulation model to evaluate the cost-effectiveness of adding SGLT2 inhibitors to standard therapy compared with standard therapy alone among patients with HFrEF. A published prediction model informed transition probabilities for all-cause death and hospitalization for heart failure. Time-varying effects of SGLT2 inhibitors, medical costs, and utility values were derived from published literature. Scenario analyses in different timeframes were conducted to assess the trend of cost-effectiveness over time.Results: Compared with standard therapy alone, SGLT2 inhibitors plus standard therapy were cost-effective at a willingness-to-pay (WTP) threshold of $12,741 per quality-adjusted life year (QALY) gained in two years. The incremental cost-effectiveness ratio (ICER) decreased from $12,346.07/QALY at 0.5 year to $9,355.66/QALY at two years. One-direction sensitivity analysis demonstrated that the cost-effectiveness of SGLT2 inhibitors was most sensitive to the cost of SGLT2 inhibitors, the cost of hospitalization for heart failure, the cost of standard therapy for heart failure, and the baseline risks of all-cause death and hospitalization for heart failure. Probabilistic sensitivity analysis proved the robustness of the results.Adding SGLT2 inhibitors to standard therapy was cost-effective in Chinese patients with HFrEF. Longer treatment appeared to be more economically favorable but further explorations are warranted.