Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have shown promise in reducing cardiovascular mortality and hospitalization due to heart failure (HF), a significant global health issue. This study aims to evaluate the incremental net benefit (INB) of SGLT-2i in HF patients through a systematic review and meta-analysis of cost-utility studies.
Methods: We searched five databases from their inception until Aug 30, 2024, economic evolution studies reporting cost-effectiveness and cost-utility analyses comparing SGLT-2i combined with standard triple-therapy versus standard triple-therapy alone in HF patients were selected. INB as the primary outcome was calculated in monetary units adjusted for purchasing power parity in 2022 US dollars.
Results: This review included 46 studies, with 41 studies (55 comparisons) pooled into meta-analysis. Adding SGLT2is was cost-effective compared to standard triple-therapy alone, from both healthcare system perspective (INB, $4042.08; 95 % CI, $1758.70-$6325.46) and payer perspective (INB, $12,972.84; 95 % CI, $4711.5-$21,234.22). However, subgroup analyses showed non-significant economic benefit in HF patients with preserved ejection fraction (HFpEF) both from the healthcare system perspective (INB, -$639.32; 95 % CI, -$1850.09-$571.44) and the payer perspective (INB, $3611.07; 95 % CI, -$208.49-$7430.64). Additionally, HF patients from low- and middle-income countries did not show significant economic benefit from the payer perspective (INB, $55,645.70; 95 % CI, -$51,000.00-$160,000.00).
Conclusions: The findings suggest that adding SGLT-2i is cost-effective compared to conventional standard triple-therapy alone, from both healthcare system and payer perspectives. Nevertheless, the economic benefits are limited in HFpEF and those from low- and middle-income countries. Further research is needed to explore the cost-effectiveness from a broader societal perspective.
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