Beyond clinical trials – The cost saving associated with dapagliflozin use in Portugal hospital clinical practice

• Published in: Revista portuguesa de cardiologia 2024-12, Vol.43 (12), p.685-694
• Main Authors: Brito, Dulce, Fonseca, Cândida, Franco, Fátima, Lopes, Vanessa, Gonçalves, Sara, Baptista, Rui, Sequeira, Joana, Marques, Irene, Rego, Rita, Pimenta, Joana, Silva-Cardoso, José, Lopes, Margarida, Almeida, Mário
• Format: Article
• Language: English
• Subjects: Benzhydryl Compounds - economics; Benzhydryl Compounds - therapeutic use; Clinical Trials as Topic; Cost Savings; Custos de saúde; Dapagliflozin; Dapagliflozina; Economic burden; Encargos económicos; Glucosides - economics; Glucosides - therapeutic use; Healthcare costs; Heart failure; Heart Failure - drug therapy; Heart Failure - economics; HF hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitalização por IC; Humans; Insuficiência cardíaca; iSGLT2; Male; Portugal; SGLT2i; Sodium-Glucose Transporter 2 Inhibitors - economics; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
• ISSN: 0870-2551; 2174-2030; 2174-2030
• DOI: 10.1016/j.repc.2024.04.012

Heart failure (HF) is a clinical syndrome associated with substantial morbidity, mortality, and healthcare costs. Dapagliflozin has proven efficacy in reducing the risk of death and hospitalization in HF patients, regardless of left ventricular ejection fraction (LVEF). This paper aimed to project the potential impact of dapagliflozin on healthcare costs related to HF subsequent hospitalizations (HFHs) in Portuguese hospitals. The total number of HF-related hospitalizations (hHF), HFHs, and the average length of stay for patients with a primary diagnosis of HF from six Portuguese hospitals, between January 2019 and December 2021, were collected and aggregated by hospital classification. Costs associated with HFHs were calculated according to Portuguese legislation and considering conservative, average, and complex approaches. Cost-saving projections were based on extrapolations from hHF risk reductions reported in dapagliflozin clinical trials. Considering a 26% risk reduction in hHF reported on pooled-analysis of DAPA-HF and DELIVER as the expected reduction in HFHs, the use of dapagliflozin would be associated with cost savings ranging from EUR 1612851.54 up to EUR 6587360.09, when considering all hospitals and the different approaches, between 2019 and 2021. A similar projection is observed based on 24% RRR derived by weighting DAPA-HF and DELIVER sub-analyses and PORTHOS epidemiological data. In this projection, dapagliflozin use in all eligible hHF patients is associated with a significant reduction in direct costs. Our data support that, in addition to the improvements in HF-related outcomes, dapagliflozin may have a significant economic impact on healthcare costs in Portuguese hospitals. A insuficiência cardíaca (IC) é uma síndrome clínica associada a uma elevada morbidade, mortalidade e despesa com custos de saúde. A dapagliflozina demonstrou ser eficaz na redução do risco de morte e hospitalização em doentes com IC, independentemente da fração de ejeção do ventrículo esquerdo. Este artigo visa projetar o potencial impacto da dapagliflozina na redução dos custos relacionados com hospitalizações subsequentes por IC em hospitais portugueses. Foi recolhido, e posteriormente analisado de forma agregada em clusters, o número total de hospitalizações por IC, hospitalizações subsequentes por IC e duração média de internamento dos doentes com diagnóstico primário de IC em seis hospitais portugueses, entre janeiro de 2019 e dezembro de 2021. Os custos relac