Cost-utility analysis of empagliflozin for heart failure in the Philippines

Empagliflozin confers cardioprotective benefits among patients with heart failure, across the range of ejection fraction (EF), regardless of type 2 diabetes status. The long-term cost-effectiveness of empagliflozin for the treatment of heart failure (HF) in the Philippines remains unclear. This study aims to determine the economic benefit of adding empagliflozin to the standard of care (SoC) vs the SoC alone for HF in the Philippines. Using a Markov model, we predicted lifetime costs and clinical outcomes associated with treating HF in the Philippine setting. We used estimates of treatment efficacy, event probabilities, and derivations of utilities from the EMPEROR trials. Costs were derived from hospital tariffs and expert consensus. Separate analyses were performed for patients with left ventricular EF > 40%, categorized under mid-range ejection fraction or preserved ejection fraction (HFmrEF/HFpEF), and patients with left EF ≤ 40%, categorized under HF with reduced ejection fraction (HFrEF). Our model predicted an average of 0.09 quality-adjusted life year (QALY) gains among HFmrEF/HFpEF patients and HFrEF patients when empagliflozin was compared to SoC. The addition of empagliflozin in the treatment results in a discounted incremental lifetime cost of PHP 62,692 (USD 1,129.99) and PHP 17,215 (USD 308.67) for HFmrEF/HFpEF and HFrEF, respectively. The incremental cost-effectiveness ratio (ICER) of empagliflozin is PHP 198,270 (USD 3,570.72)/QALY and PHP 742,604 (USD 13,385.08)/QALY for HFrEF and HFmrEF/HFpEF, respectively. This study employed parameters derived from short-term clinical trial data, alongside metrics representative of Asian populations, which are not specific to the Philippine cohort. Adding empagliflozin to the SoC in comparison to the SoC is associated with improved clinical outcomes and quality-of-life, at additional costs for both HFrEF and HFmrEF/HFpEF. Heart failure is a medical condition where the heart pumps blood to the rest of the body less than it should. Patients with type 2 diabetes – a long-term condition where patients have excessive blood sugar – are much more prone to developing heart failure, develop it earlier, and have more severe heart failure consequences such as hospitalization and death. A new medication for type 2 diabetes, called empagliflozin, reduces these severe consequences and can lead to better health. This medication has been shown to represent good value-for-money in several countries, but economic studies in the Philippines have not yet been carried out. Therefore, we performed mathematical calculations and forecasted the medical costs and benefits of adding this medication to the standard treatment of patients with type 2 diabetes in the Philippines. Our results showed that taking empagliflozin once-a-day increased the number of healthy life years (called quality-adjusted life years or QALYs) in Philippine patients with diabetes by almost 9%. The cost for one QALY gained was PHP 742,604 (USD 13,385) for patients with normal- to moderately-weak heart pump and PHP 198,270 (USD 3,571) for patients with severely-weak heart pump. These results suggest that empagliflozin may represent good value-for-money for patients with heart failure in the Philippines, depending on the payer’s willingness to pay for the gain of an additional year of healthy life.