A cost-effectiveness analysis of empagliflozin for heart failure patients across the full spectrum of ejection fraction in Spain: combined results of the EMPEROR-Preserved and EMPEROR-Reduced trials

ABSTRACT

Background

Heart failure (HF) is a chronic condition with considerable clinical burden for patients and economic burden for healthcare systems. Treatment for HF is typically based on ejection fraction (EF) phenotype. The cost-effectiveness of empagliflozin + standard of care (SoC) compared to SoC has been examined for HF phenotypes below or above 40% EF separately, but not across the full spectrum of EF in Spain.

Methods

The results of two preexisting, validated, and published phenotype-specific Markov cohort models were combined using a population-weighted approach, reflecting the incidence of each phenotype in the total HF population in Spain. A probabilistic sensitivity analysis was performed by sampling each model’s probabilistic results.

Results

Empagliflozin + SoC compared to SoC resulted in increased life-years (LYs) (6.48 vs. 6.35), quality-adjusted LYs (QALYs) (4.80 vs. 4.63), and healthcare costs (€19,090 vs. €18,246), over a lifetime time horizon for the combined HF population in Spain. The incremental cost-effectiveness ratio (ICER) was €5,089/QALY. All subgroup, scenario, and probabilistic ICERs were consistently below €10,000/QALY.

Conclusions

Empagliflozin is the first treatment with established efficacy and cost-effectiveness for HF patients across EF from the perspective of healthcare payers in Spain. Empagliflozin also proved to be cost-effective for all subgroups of patients included in the analysis.

KEYWORDS:

• Cost-effectiveness
• ejection fraction
• empagliflozin
• heart failure
• SGLT inhibitors
• Spain

Acknowledgments

This work has previously been displayed as a poster presentation titled ‘Empagliflozin for Heart Failure Patients Irrespective of Ejection Fraction in Spain: A Cost-Effectiveness Study’ presented at the ISPOR Europe 2022 conference held in Vienna, Austria, November 6-9, 2022.

Declarations of interest

X García Moll has received consultancy fees from Boehringer Ingelheim, AstraZeneca, and Novo Nordisk. F Croci has received consultancy fees from Boehringer Ingelheim. A Solé and E Hartgers-Gubbels are employees of Boehringer Ingelheim. MA Calleja-Hernández has affiliations with Boehringer Ingelheim, AstraZeneca, and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer declarations

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions statement

F. Croci contributed to the design and implementation of the study, to the analysis of the results, and to manuscript writing. X. García Moll and M.A. Calleja-Hernández provided clinical expertise and validation for the manuscript and contributed to its writing. A. Solé contributed to the design and implementation of the study, and manuscript writing. E. Hartgers-Gubbels contributed to manuscript writing. All authors have reviewed and approved the final version of the manuscript, and each has contributed intellectually to its content.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2024.2324027

Additional information

Funding

This paper was funded by Boehringer Ingelheim Intl GmbH.