The cost‐effectiveness of dapagliflozin in heart failure with preserved or mildly reduced ejection fraction: A European health‐economic analysis of the DELIVER trial

Aims To determine the cost‐effectiveness of dapagliflozin, added to usual care, in patients with heart failure (HF) with mildly reduced or preserved ejection fraction for the UK, German and Spanish payers using detailed patient‐level data from the Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure (DELIVER) trial. Methods and results A lifetime Markov state‐transition cohort model was developed. Quartiles of the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ‐TSS) defined health states and monthly transition count data informed transition probabilities. Multivariable generalized estimating equations captured the incidence of HF hospitalizations and urgent HF visits, while cardiovascular deaths and all‐cause mortality were estimated using adjusted parametric survival models. Health state costs were assigned to KCCQ‐TSS quartiles (2021 British pound [GBP]/Euro) and patient‐reported outcomes were sourced from DELIVER. Future values of costs and effects were discounted according to country‐specific rates. In the UK, dapagliflozin treatment was predicted to increase quality‐adjusted life years (QALYs) and life‐years by 0.231 and 0.354, respectively, and extend the time spent in the best quartile of KCCQ‐TSS by 4.2 months. Comparable outcomes were projected for Germany and Spain. The incremental cost‐effectiveness ratios were £7761, €9540 and €5343/QALY in the UK, Germany and Spain, respectively. According to regional willingness‐to‐pay thresholds, 91%, 89% and 92% of simulations in the UK, Germany and Spain, respectively, were cost‐effective following probabilistic sensitivity analyses. Conclusion Dapagliflozin, added to usual care, is very likely cost‐effective for HF with mildly reduced or preserved ejection fraction in several European countries. In this analysis of patient‐level data from the DELIVER trial, dapagliflozin added to usual care, versus usual care alone, was very likely cost‐effective for the treatment of heart failure with mildly reduced or preserved ejection fraction for UK, German and Spanish payers. HHF, hospitalization for heart failure; ICER, incremental cost‐effectiveness ratio; QALY, quality‐adjusted life‐year.