摘要
Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists(MRAs).Methods:Data from the RALES,EPHESUS,EMPHASIS,DAPA-HF,and EMPEROR-Reduced trials were includ-ed.We calculated the risk-ratio(RR)for a composite of cardiovascular death or heart failure hospitalization(CV death-HHF),all-cause mortality,and heart failure hospitalization(HHF)between MRAs and SGLT2i.A Markov model was developed to simulate the progression of HFrEF over 5 years.The primary outcome was incremental cost-effectiveness ratio(ICER),measured by cost per quality-adjusted life-year(QALY)gained.Results:We observed a similar benefit in CV death-HHF(RR 1.04;95%CI 0.82–1.31),all-cause mortality(RR 0.91;95%CI 0.78–1.06),and HHF(RR 1.05;95%CI 0.84–1.31)between MRAs and SGLT2i.In a 5-year model,no difference in survival was observed between treatments.MRAs were associated with lower cost($63,135.52 vs.$80,365.31)and more QALYs gained per patient(2.53 versus 2.49)than SGLT2i.The ICER for SGLT2i versus MRAs was$-172,014.25/QALY,in favor of MRAs.Conclusion:MRAs and SGLT2i provided similar benefits;however,MRAs were a more cost-effective treatment than SGLT2i.
