Objective  To compare the cost-utility analysis of sacubitril/valsartan, dapagliflozin and empagliflozin in the treatment of heart failure with reduced ejection fraction (HFrEF) from the perspective of China’s health system, so as to provide a basis for the selection of clinical treatment drugs.

Methods  A Markov model was constructed according to clinical trials such as DAPA-HF and EMPEROR-Reduced,  to simulate the development process of HFrEF. The cost-utility of sacubitril/valsartan, dapagliflozin and empagliflozin in patients with HFrEF was evaluated and the sensitivity of results was analyzed.

Results  The incremental cost-utility ratio (ICUR) of dapagliflozin compared with empagliflozin was 20 248.63 yuan/QALY, the ICUR of sacubitril/valsartan compared with empagliflozin was 23 860.98 yuan/QALY, and the ICUR of sacubitril/valsartan compared with dapagliflozin was 28 423.95 yuan/QALY. The pairwise ICUR of the three drugs were less than one times the per capita GDP in 2021. The probability sensitivity analysis showed that when the willingness-to-pay threshold was greater than 30 000 yuan/QALY, the iterations cost-effective of sacubitril/valsartan compared with dapagliflozin and empagliflozin was 100%.

Conclusion  The economic efficiency of sacubitril/valsartan in the treatment of HFrEF is better than dapagliflozin, which is better than empagliflozin.

1.中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004.

2.Wang H, Chai K, Du M, et al. Prevalence and incidence of heart failure among urban patients in china: a national population-based analysis[J]. Circ Heart Fail, 2021, 14(10): e008406. DOI: 10.1161/circheartfailure.121.008406.

3.王宙, 周琳, 刘洋,等. 慢性心力衰竭的流行病学研究现状及其防治研究进展[J].中国循证心血管医学杂志, 2019, 11(8): 1022-1024. [Wang Z, Zhou L, Liu Y, et al. Epidemiological research status and progress in prevention and treatment of chronic heart failure[J]. Chinese Journal of Evidence-Bases Cardiovascular Medicine, 2019, 11(8): 1022-1024.] DOI: 10.3969/j.issn.1674-4055.2019.08.36.

4.宣建伟, 陶立波, 朱水清, 等. 真实世界中我国心力衰竭患者非直接医疗费用和患者生命质量研究[J].中国医疗保险, 2017, (3): 61-64. [Xuan JW, Tao LB, Zhu SQ, et al. Real World Survey of non-direct medical cost and quality of life for heart failure patients of China[J].China Health Insurance, 2017, (3): 61-64.] DOI: 10.19546/j.issn.1674-3830.2017.3.013.

5.Huang J, Yin H, Zhang M, et al. Understanding the economic burden of heart failure in China: impact on disease management and resource utilization[J]. J Med Econ, 2017, 20(5): 549-553. DOI: 10.1080/13696998.2017.1297309.

6.Theresa A, Marco M, Marianna A, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur J Heart Fail, 2021, 42: 3599-3726. DOI: 10.1093/eurheartj/ehab368.

7.王志燕, 陈晨, 吕强, 等. 2021年ESC急慢性心力衰竭诊断与治疗指南解读[J]. 中华心血管病杂志, 2021, 49(12): 1252-1255. [Wang ZY, Chen C, Lyu Q, et al. Highlights and interpretation of the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Chinese Journal of Cardiology, 2021, 49(12): 1252-1255.] DOI: 10.3760/cma.j.cn112148-20210929-00840.

8.Solomon SD, Jhund PS, Claggett BL, et al. Effect of dapagliflozin in patients with HFrEF treated with sacubitril/valsartan[J]. JACC-HEART Fail, 2020, 8(10): 811-818. DOI: 10.1016/j.jchf.2020.04.008.

9.Milton P, Stefan D, Javed B, et al. Influence of neprilysin inhibition on the efficacy and safety of empagliflozin in patients with chronic heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial[J]. Eur Heart Journal, 2021, 42: 671-680. DOI: 10.1093/eurheartj/ehaa968.

10.Greene SJ, Fonarow GC, Vaduganathan M, et al. The vulnerable phase after hospitalization for heart failure[J]. Nat Rev Cardiol, 2015, 12(4): 220-229. DOI: 10.1038/nrcardio.2015.14

11.Mcmurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction[J]. N Engl J Med. 2019, 381: 1995-2008. DOI: 10.1056/NEJMoa1911303.

12.Yao G, Freemantle N, Flather M, et al. Long-term cost-effectiveness analysis of nebivolol compared with standard care in elderly patients with heart failure:an individual patient-based simulation model[J]. Pharmacoeconomics, 2008, 26: 879-889. DOI: 10.2165/00019053-2008 26100-00007.

13.Yao G, Freemantle N, Calvert MJ, et al. The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverterdefibrillator[J]. Eur Heart J, 2007, 28: 42-51. DOI: 10.1093/eurheartj/ehl382.

14.刘国恩, 主编. 中国药物经济学评价指南及导读（2015年版）[M].北京: 科学出版社, 2015: 23-33.

15.中国药物经济学评价指南课题组. 中国药物经济学评价指南[J]. 中国药物经济学, 2011, 6(3): 11-48. DOI: 10.3969/j.issn.1673-5846.2011.03.001.

16.McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. N Engl J Med, 2014, 371(11): 993-1004. DOI: 10.1056/NEJMoa1409077.

17.Palaguachi GI, Frishman W. A review of the role of type 2 diabetes and SGLT2 inhibitors in heart failure with preserved ejection fraction[J]. Cardiol Rev, 2022, 30(5): 274-278. DOI: 10.1097/CRD.0000000000000399.

18.Jawad HB, Pooja D, Ersilia MD, et al. Effects of dapagliflozin according to the heart failure collaboratory medical therapy score: insights from DAPA-HF[J]. JACC Heart Fail, 2022, 10(8): 543-555. DOI: 10.1016/j.jchf.2022.03.009.

19.Maejima Y. SGLT2 inhibitors play a salutary role in heart failure via modulation of the mitochondrial function[J]. Front Cardiovasc Med, 2019, 6: 186. DOI: 10.3389/fcvm.2019.00186.

20.Yao NT, Yao HT, Nicholas L, et al. Comparing sacubitril/valsartan against sodium-glucose cotransporter 2 inhibitors in heart failure: a systematic review and network meta-analysis[J]. Clinical Drug Investigation, 2022, 42: 1-16. DOI: 10.1007/s40261-021-01098-3.

21.Alberto A, Konstantinos P, Kimon S, et al. Relative efficacy of sacubitril-valsartan, vericiguat, and SGLT2 inhibitors in heart failure with reduced ejection fraction:a systematic review and network meta-analysis[J]. Cardiovascular Drug Ther, 2021, 35(5): 1067-1076. DOI: 10.1007/s10557-020-07099-2.