Summary: | For patients in New York Heart Association (NYHA) class II, the incremental cost-effectiveness ratio (ICER) for dapagliflozin plus standard therapy (DAPA + ST) versus standard therapy (ST) is $8,760 per quality-adjusted life-year (QALY). For patients in class III or IV, DAPA + ST is dominated by ST: DAPA + ST is more costly and associated with fewer QALYs. This result was associated with uncertainty given the evidence regarding the clinical efficacy of DAPA + ST in NYHA classes III and IV, as shown in the DAPA-HF trial. Given concerns with the lack of robust clinical information to inform the comparison of DAPA +ST and sacubitril-valsartan plus standard therapy (SAC-VAL + ST), the cost-effectiveness of DAPA + ST versus SAC-VAL + ST in this indication cannot be assessed. CADTH expressed concern over the lack of flexibility and transparency with the submitted model. While the submission is not representative of best practices, the limitations are unlikely to impact the conclusion that, based on the DAPA-HF trial evidence for DAPA + ST efficacy by NYHA class, DAPA + ST is cost-effective for patients in NYHA class II but not for patients in classes III or IV.
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