基于 EMPEROR-Preserved 临床试验,Empagliflozin (JARDIANCE®) 治疗法国射血分数保留型心力衰竭患者的公共卫生影响和成本效益。

IF 2 Q2 ECONOMICS
PharmacoEconomics Open Pub Date : 2024-01-01 Epub Date: 2023-08-22 DOI:10.1007/s41669-023-00432-z
Laurent Fauchier, Nicolas Lamblin, Jean Tardu, Lucile Bellier, Harinala Groyer, Deborah Ittah, Julien Chollet, Stephan Linden, Pierre Levy
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引用次数: 0

摘要

简介EMPEROR-Preserved试验证明了empagliflozin治疗射血分数保留型心力衰竭(HFpEF)的有效性和安全性,该试验显示心血管死亡或HF住院的综合风险降低了21%[危险比(HR)0.79;95%置信区间(CI)0.69-0.90,P 方法]:对已发表的马尔可夫模型进行了改编,从集体角度出发,比较了在法国接受empagliflozin和SoC治疗的患者与仅接受SoC治疗的患者在健康和经济方面的结果。该模型模拟了试验中的意向治疗(ITT)人群,在代表堪萨斯城心肌病问卷-临床综合评分(KCCQ-CSS)四分位数的四种相互排斥的健康状态之间转换。对于每个治疗组,该模型估算了(终生时间范围内)经济效益和健康结果(避免的高血压住院治疗、获得的生命年数和质量调整生命年数 (QALY)),从而计算出增量成本效益比 (ICER)。所使用的资源是通过将法国高血压调查(FREESH)队列数据与法国医疗保险理赔数据配对得出的,而效用则是根据按法国费率估价的 EQ-5D-5L 问卷得出的。经济和健康结果均按 2.5% 的年贴现率折现:该模型预测,使用恩格列净治疗HFpEF患者,每治疗1000名患者,可避免74例HF住院和15例心血管事件导致的死亡,平均可获得1个月的总生存期(7.24年,安慰剂为7.16年)和0.11个QALY(6.14年,安慰剂为6.03年)。因避免住院而节省的费用部分抵消了恩格列净的成本。ICER为每增益生命年18,597欧元,每增益QALY 13,980欧元。进行的敏感性分析表明,在25000欧元/QALY阈值下,empagliflozin具有65%成本效益的可能性:基础研究结果表明,在法国,empagliflozin是一种具有成本效益的HFpEF治疗策略,此外,它还能预防HF住院和死亡,从而对公共卫生产生影响。敏感性分析表明,65%的模拟结果低于25,000欧元/QALY阈值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Public Health Impact and Cost-Effectiveness of Empagliflozin (JARDIANCE®) in the Treatment of Patients with Heart Failure with Preserved Ejection Fraction in France, Based on the EMPEROR-Preserved Clinical Trial.

Introduction: The efficacy and safety of empagliflozin in the treatment of heart failure with preserved ejection fraction (HFpEF) were demonstrated in the EMPEROR-Preserved trial, which showed a 21% reduction in combined risks of cardiovascular death or HF hospitalization [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69-0.90, p < 0.001] and a 27% reduction in the total number of HF hospitalizations (HR 0.73; 95% CI 0.61-0.88, p < 0.001) compared with placebo. On the basis of these results, the present study aimed to assess the cost-effectiveness of empagliflozin + standard of care (SoC) compared with SoC alone in the treatment of HFpEF.

Methods: A published Markov model was adapted to compare the health and economic outcomes in France, considering a collective perspective, in patients treated with empagliflozin in addition to SoC versus patients treated by SoC alone. The model simulated the intention-to-treat (ITT) population of the trial, transitioning between four mutually exclusive health states representing the quartiles of the Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS). For each arm, the model estimated (over a lifetime time horizon) the economics and the health outcomes (HF hospitalizations avoided, and life years and quality-adjusted life years (QALYs) gained) to calculate the incremental cost-effectiveness ratios (ICERs). The resources used were derived by pairing the FREnch Survey on HF (FRESH) cohort data to French health insurance claims data, and the utilities were derived on the basis of the EQ-5D-5L questionnaire valued on the French tariff. Both economic and health outcomes were discounted at a 2.5% annual rate.

Results: The model predicted that treatment of HFpEF patients with empagliflozin would prevent, for 1000 patients treated, 74 HF hospitalizations and 15 deaths attributable to cardiovascular events, resulting on average in a gain of 1 month in overall survival (7.24 versus 7.16 years with placebo) and 0.11 QALYs (6.14 versus 6.03 with placebo). Empagliflozin costs were partially offset by the cost savings from avoided hospitalizations. The ICERs were €18,597 per life year gained and €13,980 per QALY gained. The sensitivity analyses conducted showed that empagliflozin has a 65% probability to be cost-effective under the €25,000/QALY threshold.

Conclusions: The base-case results showed that empagliflozin is a cost-effective strategy for management of HFpEF, in addition to the impact on public health by preventing HF-hospitalizations and deaths in France. Sensitivity analyses suggest that 65% of simulations are under the €25,000/QALY threshold.

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来源期刊
CiteScore
3.50
自引率
0.00%
发文量
64
审稿时长
8 weeks
期刊介绍: PharmacoEconomics - Open focuses on applied research on the economic implications and health outcomes associated with drugs, devices and other healthcare interventions. The journal includes, but is not limited to, the following research areas:Economic analysis of healthcare interventionsHealth outcomes researchCost-of-illness studiesQuality-of-life studiesAdditional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in PharmacoEconomics -Open may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.
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