Abstract：
BACKGROUND: Three medications are now guideline-recommended treatments for heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), however, the cost-effectiveness of these agents in combination has yet to be established.
OBJECTIVE: The purpose of this study was to determine the cost-effectiveness of mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium glucose co-transporter 2 inhibitors (SGLT2is) in individuals with HFmrEF/HFpEF.
METHODS: Using a 3-state Markov model, we performed a cost-effectiveness study using simulated cohorts of 1,000 patients with HFmrEF and HFpEF. Treatment with 1-, 2-, and 3-drug combinations was modeled. Based on a United States health care sector perspective, outcome data was used to calculate incremental cost-effectiveness ratios (ICERs) in 2023 United States dollars based on a 30-year time horizon.
RESULTS: Treatment with MRA, MRA+SGLT2i, and MRA+SGLT2i+ARNI therapy resulted in an increase in life years of 1.04, 1.58, and 1.80 in the HFmrEF subgroup, respectively, and 0.99, 1.54, and 1.77 in the HFpEF subgroup, respectively, compared with placebo. At a yearly cost of $18, MRA therapy resulted in ICERs of $10,000 per quality-adjusted life year (QALY) in both subgroups. The ICER for the addition of SGLT2i therapy ($4,962 per year) was $113,000 per QALY in the HFmrEF subgroup and $141,000 in the HFpEF subgroup. The addition of ARNI therapy ($5,504 per year) resulted in ICERs >$250,000 per QALY in both subgroups. If SGLT2i and ARNI were available at generic pricing the ICERs become <$10,000 per QALY in both EF subgroups. Outcomes were highly sensitive to assumed benefit in cardiovascular death.
CONCLUSIONS: For patients with heart failure, MRA was of high value, SGLT2i was of intermediate value, and ARNI was of low value in both HFmrEF and HFpEF subgroups. For patients with HFmrEF/HFpEF increased use of MRA and SGLT2i therapies should be encouraged and be accompanied with efforts to lower the cost of SGLT2i and ARNI therapies.
OBJECTIVE: The purpose of this study was to determine the cost-effectiveness of mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium glucose co-transporter 2 inhibitors (SGLT2is) in individuals with HFmrEF/HFpEF.
METHODS: Using a 3-state Markov model, we performed a cost-effectiveness study using simulated cohorts of 1,000 patients with HFmrEF and HFpEF. Treatment with 1-, 2-, and 3-drug combinations was modeled. Based on a United States health care sector perspective, outcome data was used to calculate incremental cost-effectiveness ratios (ICERs) in 2023 United States dollars based on a 30-year time horizon.
RESULTS: Treatment with MRA, MRA+SGLT2i, and MRA+SGLT2i+ARNI therapy resulted in an increase in life years of 1.04, 1.58, and 1.80 in the HFmrEF subgroup, respectively, and 0.99, 1.54, and 1.77 in the HFpEF subgroup, respectively, compared with placebo. At a yearly cost of $18, MRA therapy resulted in ICERs of $10,000 per quality-adjusted life year (QALY) in both subgroups. The ICER for the addition of SGLT2i therapy ($4,962 per year) was $113,000 per QALY in the HFmrEF subgroup and $141,000 in the HFpEF subgroup. The addition of ARNI therapy ($5,504 per year) resulted in ICERs >$250,000 per QALY in both subgroups. If SGLT2i and ARNI were available at generic pricing the ICERs become <$10,000 per QALY in both EF subgroups. Outcomes were highly sensitive to assumed benefit in cardiovascular death.
CONCLUSIONS: For patients with heart failure, MRA was of high value, SGLT2i was of intermediate value, and ARNI was of low value in both HFmrEF and HFpEF subgroups. For patients with HFmrEF/HFpEF increased use of MRA and SGLT2i therapies should be encouraged and be accompanied with efforts to lower the cost of SGLT2i and ARNI therapies.
摘要：
背景：三种药物现在是指南推荐的治疗方法，用于治疗射血分数轻度降低或保留的心力衰竭（HFmrEF/HFpEF），然而,这些药物组合的成本效益尚未确定。
目的：本研究的目的是确定盐皮质激素受体拮抗剂（MRA）的成本效益，血管紧张素受体-脑啡肽抑制剂（ARNIs），和钠葡萄糖共转运蛋白2抑制剂（SGLT2is）在患有HFmrEF/HFpEF的个体中。
方法：使用3状态马尔可夫模型，我们使用1,000例HFmrEF和HFpEF患者的模拟队列进行了成本-效果研究.治疗1-，2-,和3种药物组合进行建模。基于美国医疗保健行业的观点，根据30年的时间范围,使用结局数据计算2023年的增量成本效益比(ICER).
结果：MRA治疗，MRA+SGLT2i,MRA+SGLT2i+ARNI治疗导致HFmrEF亚组的寿命年增加1.04、1.58和1.80，分别,HFpEF亚组中的0.99、1.54和1.77，分别,与安慰剂相比。MRA治疗每年花费18美元，在两个亚组中每个质量调整生命年（QALY）的ICER为10,000美元。在HFmrEF亚组中，增加SGLT2i治疗的ICER（每年4,962美元）为每个QALY113,000美元，在HFpEF亚组中为141,000美元。增加ARNI治疗（每年5,504美元）导致两个亚组中每个QALY的ICER>250,000美元。如果SGLT2i和ARNI以通用价格提供，则在两个EF子组中，ICER的每QALY均<10,000美元。结果对心血管死亡的假定益处高度敏感。
结论：对于心力衰竭患者，MRA很有价值,SGLT2i具有中等价值，在HFmrEF和HFpEF亚组中ARNI的值较低。对于HFmrEF/HFpEF患者，应鼓励增加MRA和SGLT2i治疗的使用，并努力降低SGLT2i和ARNI治疗的成本。
目的：本研究的目的是确定盐皮质激素受体拮抗剂（MRA）的成本效益，血管紧张素受体-脑啡肽抑制剂（ARNIs），和钠葡萄糖共转运蛋白2抑制剂（SGLT2is）在患有HFmrEF/HFpEF的个体中。
方法：使用3状态马尔可夫模型，我们使用1,000例HFmrEF和HFpEF患者的模拟队列进行了成本-效果研究.治疗1-，2-,和3种药物组合进行建模。基于美国医疗保健行业的观点，根据30年的时间范围,使用结局数据计算2023年的增量成本效益比(ICER).
结果：MRA治疗，MRA+SGLT2i,MRA+SGLT2i+ARNI治疗导致HFmrEF亚组的寿命年增加1.04、1.58和1.80，分别,HFpEF亚组中的0.99、1.54和1.77，分别,与安慰剂相比。MRA治疗每年花费18美元，在两个亚组中每个质量调整生命年（QALY）的ICER为10,000美元。在HFmrEF亚组中，增加SGLT2i治疗的ICER（每年4,962美元）为每个QALY113,000美元，在HFpEF亚组中为141,000美元。增加ARNI治疗（每年5,504美元）导致两个亚组中每个QALY的ICER>250,000美元。如果SGLT2i和ARNI以通用价格提供，则在两个EF子组中，ICER的每QALY均<10,000美元。结果对心血管死亡的假定益处高度敏感。
结论：对于心力衰竭患者，MRA很有价值,SGLT2i具有中等价值，在HFmrEF和HFpEF亚组中ARNI的值较低。对于HFmrEF/HFpEF患者，应鼓励增加MRA和SGLT2i治疗的使用，并努力降低SGLT2i和ARNI治疗的成本。
