Budget Impact Analysis of Dapagliflozin in Treating Patients With Heart Failure With Reduced Ejection Fraction From the Perspective of Malaysian Public Healthcare System

• Published in: Clinical therapeutics 2024-11, Vol.46 (11), p.e1-e9
• Main Authors: Tan, Yi Jing, Low, Joo Zheng, Ong, Siew Chin
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Adverse events; Benzhydryl Compounds - economics; Benzhydryl Compounds - therapeutic use; Beta blockers; Budget impact analysis; Budgets; Chronic illnesses; Comorbidity; Congestive heart failure; Cost analysis; Cost-Benefit Analysis; Dapagliflozin; Diabetes; Diuretics; Ejection fraction; GDP; Glucosides - economics; Glucosides - therapeutic use; Gross Domestic Product; Health care; Health care expenditures; Heart failure; Heart Failure - drug therapy; Heart Failure - economics; Humans; Impact analysis; Malaysia; Mortality; Patients; Public health; Quality of life; Reduced ejection fraction; Sodium-Glucose Transporter 2 Inhibitors - economics; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stroke Volume - drug effects
• ISSN: 0149-2918; 1879-114X; 1879-114X
• DOI: 10.1016/j.clinthera.2024.08.008

•The 5-year financial impact of using dapagliflozin to treat HFrEF is favorable.•Dapagliflozin generates cost-savings primarily by reducing hospitalization for HF.•The budget impact is sensitive to the cost of dapagliflozin and changes in diuretic use.•Policymakers in Malaysia should consider offering dapagliflozin to HFrEF patients, noting that a steady increase in adoption will result in a modest budget increase over the longer term. This is a budget impact analysis that compared the scenario of treating heart failure with reduced ejection fraction (HFrEF) using dapagliflozin plus standard of care (SoC) versus a scenario without dapagliflozin, from the perspective of Ministry of Health (MOH) Malaysia over a 5-year time horizon. A Microsoft Excel-based cost calculator was developed for such comparison. The estimated size of eligible population, uptake rates for dapagliflozin, as well as costs related to drugs, clinical events, and adverse events were based on published data, official tariffs, and databases, and expert opinion. Clinical data from the DAPA-HF trial were used to inform efficacy and safety inputs (i.e., hospitalization for heart failure (hHF), cardiovascular death, and adverse events). Results were reported as total annual and cumulative costs (in 2023 Malaysian Ringgits [RM], United States Dollars [USD], and European Union Euros, [EUR]; with exchange rates of 1 USD = RM 4.40 and 1 EUR = RM 4.90]), as well as the number of clinical events. Sensitivity and scenario analyses were also conducted. The base-case analysis estimated that over a five-year period, the adoption of dapagliflozin for HFrEF treatment would result in a cumulative cost-saving of RM 2.6 million (USD 0.6 million/EUR 0.5 million), representing a 0.3% reduction in costs, driven primarily by reduced expenditure on hHF. Moreover, dapagliflozin treatment would lead to 731 fewer hHF and 366 fewer cardiovascular deaths. Sensitivity and scenario analyses revealed that the results were most sensitive to assumptions regarding loop diuretic requirements and the cost of dapagliflozin. Although cost savings or a net-zero balance were projected for the first four years, an anticipated 2.5% annual increase in dapagliflozin uptake in the longer term would lead to additional costs for the MOH, starting from the fifth year. Incorporating dapagliflozin into the SoC can improve health outcomes for HFrEF patients and may generate cost savings, potentially easing the economic strain of HFrEF manag