Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Addition to Standard Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis.
Nattakrit Tongpoonsakdi, Amarit Tansawet, Teerapat Yingchoncharoen et al.
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In 30 seconds
This systematic review and random-effects meta-analysis assessed the cost-effectiveness of adding SGLT2 inhibitors and/or angiotensin receptor-neprilysin inhibitors to traditional guideline-directed therapy for chronic heart failure. It included 70 economic evaluations identified through October 2024 and compared results by heart failure phenotype, country income level, and analytic perspective. For HFrEF in high-income countries, adding an SGLT2 inhibitor was cost-effective from the healthcare perspective, with a pooled incremental net benefit of US $13 114.52 (95% CI: 4257.40-21 971.63). Findings for other phenotypes and income settings were often inconclusive.
Key findings
- For HFrEF in high-income countries, adding an SGLT2 inhibitor had a pooled healthcare-perspective INB of US $13 114.52 (95% CI: 4257.40-21 971.63).
- The SGLT2 inhibitor plus ARNI quadruple regimen appeared cost-effective in high- and upper-middle-income countries, but evidence was limited.
- Replacing other renin-angiotensin-aldosterone system blockers with ARNI was cost-effective only for HFrEF from a societal perspective in high-income countries (INB = US $14 843.66; 95% CI: 566.36-29 120.96).
- Evidence for SGLT2 inhibitors in upper-middle- or lower-income countries and for other heart failure phenotypes was inconclusive.
Why it matters
Economic value of newer heart failure therapies may differ by phenotype, country income level, and analytic perspective. These findings suggest that cost-effectiveness evidence is most supportive for HFrEF in high-income settings, while uncertainty remains elsewhere. This distinction is relevant when interpreting economic evaluations and considering how well their conclusions apply across health systems.
What to keep in mind
Evidence was limited for the quadruple regimen and inconclusive for several phenotypes and income settings. Some variances were imputed when not available in the included evaluations.