Dapagliflozin cost-effectiveness analysis in heart failure patients in Egypt

Figures & data

Figure 1. Markov state transition model.

Table 1. Model input values.

Input	Value (unit of measurement)	Low value	High value	Source
Age	66.32	53.056	79.584	^13
Annual Probability of Discontinuation	0.07	0.056	0.084	^13
Duration of follow up (months)	18.2	14.56	21.84	^13
Utility
Utility for KCCQ-TSS: 1–<58	0.6	0.48	0.72	^14
Utility for KCCQ-TSS: 58–<77	0.705	0.564	0.846	^14
Utility for KCCQ-TSS: 77–<92	0.773	0.6184	0.9276	^14
Utility for KCCQ-TSS: 92–100	0.833	0.6664	0.9996	^14
Utility decrement for HF hospitalization	0.321	0.2568	0.3852	^14
Utility decrement for urgent HF visit	0.036	0.0288	0.0432	^14
Dapagliflozin probabilities
Hospitalizations due to HF	0.097	0.0776	0.1164	^13
Urgent HF visits	0.004	0.0032	0.0048	^13
Cardiovascular death	0.096	0.0768	0.1152	^13
Standard of care probabilities
Hospitalization due to HF	0.134	0.1072	0.1608	^13
Urgent HF visit	0.01	0.008	0.012	^13
Cardiovascular death	0.113	0.0904	0.1356	^13
Costs
Dapagliflozin cost/tab	9.27 EGP	7.416	11.124	UHIA
ACEI cost/tab	0.81 EGP	0.648	0.972	UHIA
ARB cost/tab	1.435 EGP	1.148	1.722	UHIA
Mineralocorticoids cost/tab	0.4125 EGP	0.33	0.495	UHIA
Sacubitril valsartan cost	21.43 EGP	17.144	25.716	UHIA
B-blockers cost/cycle	63	50.4	75.6	UHIA
Diuretics cost/cycle	44.8	35.84	53.76	UHIA
Cost of hospitalization due to HF	370	336	504	UHIA
Cardiovascular specific death	22,017	17,614.064	26,421.1	UHIA
Total cost of follow up/2 months	180 EGP	160	240	UHIA
ECHO/6 months	200 EGP	320	480	UHIA

Abbreviations. HF, heart failure; KCCQ-TSS, Kansas City Cardiomyopathy Questionnaire-Total Symptom Score; UHIA, Universal Health Insurance Authority; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blockers.

Table 2. Decision analytic model results.

Model results of dapagliflozin in heart failure
Cost effectiveness analysis
Treatment strategy	Total costs (EGP)*	Difference in costs (EGP)	Total QALYs	Difference in QALYs	ICER	Interpretation
Dapagliflozin	47,901 ($10,550)	13,524 ($2,978)	4.57	0.371	36,449 ($8,028) EGP/QALY	Dapagliflozin is Cost-effective compared to standard of care
Standard of care	34,377 ($7,572)		4.20
Cost minimization analysis
Dapagliflozin annual costs per patient	EGP 10,914 ($2,404)				-EGP 21,327 ($4,697) per patient per year	Dapagliflozin is Cost-saving compared to sacubitril/valsartan
Sacubitril/valsartan Annual costs per patient	EGP 32,242 ($7,101)

Abbreviations. ICER, incremental cost-effectiveness ratio; QALY, quality adjusted life year.

*Egyptian currency converted by purchasing power parity rate to international dollars¹⁵.

Figure 2. Deterministic sensitivity analysis of dapagliflozin vs. standard of care. Abbreviations. QALY, quality adjusted life year; HF, heart failure; KCCQ-TSS, Kansas City Cardiomyopathy Questionnaire-Total Symptom Score; CV, cardiovascular. Base case = EGP 36,449, The light blue bar corresponds with the upper range, and the dark blue bar with the lower range of an input.

Figure 3. Cost-effectiveness plane of dapagliflozin vs. standard of care. Abbreviation. QALY, quality adjusted life year.

McMurray JJ, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995–2008.

 PubMed Web of Science ®Google Scholar

NICE. Single technology appraisal dapagliflozin for treating heart failure with reduced ejection fraction [ID1656]; 2020. Available from: https://www.nice.org.uk/guidance/ta679/evidence/committee-papers-pdf-9016515613

 Google Scholar

World bank website: PPP conversion factor, GDP (LCU per international $) – Egypt, Arab Re. Available from: https://data.worldbank.org/indicator/PA.NUS.PPP?locations=EG

 Google Scholar