Economic evaluation of dapagliflozin added to standard therapy in chronic heart failure in Argentina: a cost-utility analysis.

Abstract

Heart failure is associated with high morbidity, mortality, and substantial resource use. Dapagliflozin improves outcomes in heart failure, but local economic evidence for Argentina is limited. We conducted a cost-utility analysis of dapagliflozin added to standard therapy for chronic heart failure in Argentina. We conducted a cost-utility analysis from the Argentine public health system perspective using two trial-based Markov models (DAPA-HF and DELIVER populations), monthly cycles, lifetime horizon, and 3% annual discounting for costs and outcomes. Inputs were derived from published trial data and Argentine sources where available. We estimated costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), and performed deterministic and probabilistic sensitivity analyses. In the DAPA-HF model, dapagliflozin increased QALYs by 0.76 with an incremental cost of US$5069, yielding an ICER of US$6672 per QALY. In the DELIVER model, dapagliflozin increased QALYs by 0.44 with an incremental cost of US$4542, yielding an ICER of US$10,371 per QALY. At a willingness-to-pay threshold of 1 gross domestic product (GDP) per capita, the probability of cost-effectiveness was 97% (DAPA-HF) and 73% (DELIVER). Dapagliflozin added to standard therapy is likely to be cost-effective in Argentina, with greater robustness in heart failure with reduced ejection fraction. In preserved or mildly reduced ejection fraction, cost-effectiveness is compatible with a 1 GDP per capita threshold but more sensitive to key assumptions; price negotiation could improve value for money. None.