Heart failure & cardiomyopathiesResearch article
Cost-Effectiveness of Medical Therapy for Heart Failure With Mildly Reduced and Preserved Ejection Fraction
- Cost-effectiveness analysis
- 3-state Markov model
- simulated cohorts
- US health care sector perspective
- 30-year time horizon
Authors' conclusion
For patients with heart failure, MRA was of high value, SGLT2i was of intermediate value, and ARNI was of low value in both HFmrEF and HFpEF subgroups.
Study context
- Population
- Simulated patients with HF with mildly reduced or preserved EF (HFmrEF/HFpEF)simulated cohorts
- Participants
- 1,000 patients
- Comparison
- Mineralocorticoid receptor antagonists (MRA), MRA+SGLT2i and MRA+SGLT2i+ARNI vs placebo
- Outcome
- Incremental cost-effectiveness ratios (ICERs) (2023 US dollars per QALY)
- Follow-up
- 30-year time horizon
Main finding
As reported in the abstract
ICER per QALY
MRA (yearly cost $18) vs placebo, both subgroups
$10,000 per QALY
Addition of SGLT2i ($4,962 per year), HFmrEF
$113,000 per QALY
Addition of SGLT2i ($4,962 per year), HFpEF
$141,000
Addition of ARNI ($5,504 per year), both subgroups
>$250,000 per QALY
Further findings
Life years gained vs placebo
- HFmrEF: MRA, MRA+SGLT2i, MRA+SGLT2i+ARNI
- 1.04, 1.58, and 1.80
- HFpEF: MRA, MRA+SGLT2i, MRA+SGLT2i+ARNI
- 0.99, 1.54, and 1.77
ICER with SGLT2i and ARNI at generic pricing
- Both EF subgroups
- <$10,000 per quality-adjusted life year (QALY)
- Outcomes highly sensitive to assumed benefit in CV death
Original publication
Cost-Effectiveness of Medical Therapy for Heart Failure With Mildly Reduced and Preserved Ejection Fraction. JACC Heart Fail. Published 1 May 2024. doi:10.1016/j.jchf.2024.03.006
Summarised from the published abstract; every number is checked against it