达格列净治疗巴西心力衰竭伴射血分数降低：成本-效果分析

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-02-01 DOI:10.1016/j.lana.2024.100968

Marcio Coutinho Xavier Naves , Angelica Amorim Amato , Ivan Ricardo Zimmermann , Henry Maia Peixoto

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引用次数: 0

摘要

背景：心力衰竭是一种发病率和死亡率高的复杂临床综合征，已成为公共卫生的重大负担。最近，一类新的降糖药——钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂——在加入标准药物治疗后，与降低射血分数（HFrEF）的心力衰竭患者死亡率和住院率显著降低相关。考虑到缺乏成本-效果的数据，本研究旨在从巴西公共卫生系统的角度估计附加达格列净治疗HFrEF的增量成本-效果比。方法：我们建立了一个马尔可夫模型来估计1000名假设的HFrEF受试者在一生中的临床结果和成本。模型输入基于达格列净和预防心力衰竭不良后果（DAPA-HF）试验和当地数据。主要结果是每个质量调整生命年（QALY）获得的增量成本-效果比（ICER）。进行了确定性和概率敏感性分析以及情景分析。研究结果：在1000名HFrEF患者的标准护理治疗中增加达格列净，产生了366.99个额外QALY的预期价值，增量成本为1,517,878.49美元，导致每个QALY增加的ICER为4,136.08美元，考虑到巴西官方成本效益阈值（8,000美元/QALY），这是一种具有成本效益的策略。在概率敏感性分析中，96.60%的模拟也具有成本效益。在情景分析中，糖尿病患者和非糖尿病患者的结果相似。解释：在巴西，将达格列净添加到标准HFrEF治疗中可能具有成本效益。资助：本研究得到了国家卫生技术评估科学技术研究所（Instituto de avalia o de tecologias em Saúde-IATS）的支持。

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Dapagliflozin for the treatment of heart failure with reduced ejection fraction in Brazil: a cost-effectiveness analysis

Background

Heart failure, a complex clinical syndrome with high morbidity and mortality, has become a significant burden on public health. Recently, a new class of antidiabetic agents–the sodium-glucose cotransporter 2 (SGLT2) inhibitors–was associated with a significant reduction on mortality and hospitalization in HF with reduced ejection fraction (HFrEF) when added to standard pharmacological treatment. Considering the lack of data on its cost-effectiveness, the present study aims to estimate the incremental cost-effectiveness ratio of add-on dapagliflozin treatment for HFrEF from the Brazilian public healthcare system perspective.

Methods

We built a Markov model to estimate the clinical outcomes and costs of 1,000 hypothetical subjects with established HFrEF in a lifetime horizon. The model inputs were based on the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial and local data. The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses, as well as scenario analyses, were performed.

Findings

The addition of dapagliflozin to standard care treatment in 1,000 HFrEF patients yielded an expected value of 366.99 additional QALYs at an incremental cost of US$ 1,517,878.49, resulting in an ICER of US$ 4,136.08 per QALY gained, being a cost-effective strategy considering the Brazilian official cost-effectiveness threshold (US$ 8,000/QALY). In probabilistic sensitivity analyses, 96.60% of the simulations were also cost-effective. In the scenario analyses, results were similar for individuals with and without diabetes.

Interpretation

Dapagliflozin is likely to be cost-effective when added to standard HFrEF therapy in Brazil.

Funding

This study was supported by the National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde—IATS).

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.