AimTo assess the cost‐effectiveness of dapagliflozin in addition to usual care, compared with usual care alone, in a large population of patients with heart failure (HF), spanning the full range of left ventricular ejection fraction (LVEF).Methods and resultsPatient‐level data were pooled from HF trials (DAPA‐HF, DELIVER) to generate a population including HF with reduced, mildly reduced and preserved LVEF, to increase statistical power and enable exploration of interactions among LVEF, renal function and N‐terminal pro‐B‐type natriuretic peptide levels, as they are relevant determinants of health status in this population. Survival and HF recurrent event risk equations were derived and applied to a lifetime horizon Markov model with health states defined by Kansas City Cardiomyopathy Questionnaire total symptom score quartiles; costs and utilities were in the UK setting. The base case incremental cost‐effectiveness ratio (ICER) was £6470 per quality‐adjusted life year (QALY) gained, well below the UK willingness‐to‐pay (WTP) threshold of £20 000/QALY gained. In interaction sensitivity analyses, the highest ICER was observed for elderly patients with preserved LVEF (£16 624/QALY gained), and ranged to a region of dominance (increased QALYs, decreased costs) for patients with poorer renal function and reduced/mildly reduced LVEF. Results across the patient characteristic interaction plane were mostly between £5000 and £10 000/QALY gained.ConclusionsDapagliflozin plus usual care, versus usual care alone, yielded results well below the WTP threshold for the UK across a heterogeneous population of patients with HF including the full spectrum of LVEF, and is likely a cost‐effective intervention.

中文翻译：

---

达格列净治疗不同射血分数范围的心力衰竭患者的成本效益：DAPA-HF 和 DELIVER 数据的汇总分析

目的 在大量心力衰竭 (HF) 患者中评估达格列净联合常规护理与单独常规护理相比的成本效益，涵盖整个左心室射血分数 (LVEF) 范围。方法和结果患者汇集 HF 试验（DAPA-HF、DELIVER）水平的数据，生成包含 LVEF 降低、轻度降低和保留的 HF 的群体，以提高统计功效并能够探索 LVEF、肾功能和 N 末端 B 前体之间的相互作用‐型利钠肽水平，因为它们是该人群健康状况的相关决定因素。推导了生存和心力衰竭复发事件风险方程，并将其应用于生命周期马尔可夫模型，其健康状态由堪萨斯城心肌病问卷总症状评分四分位数定义；成本和公用事业是在英国环境中进行的。基本情况增量成本效益比 (ICER) 为每增加质量调整生命年 (QALY) 6470 英镑，远低于英国每增加 QALY 20 000 英镑的支付意愿 (WTP) 门槛。在交互敏感性分析中，观察到 LVEF 保留的老年患者 ICER 最高（增加 16 624 英镑/QALY），肾功能较差且肾功能降低/轻度降低的患者则处于优势区域（QALY 增加，成本降低）左心室射血分数。患者特征交互平面的结果大多在 5000 英镑到 10 000 英镑/QALY 之间增加。 结论 达格列净加常规护理与单独常规护理相比，在英国异质心力衰竭患者群体中产生的结果远低于 WTP 阈值，包括LVEF 的全谱，并且可能是一种具有成本效益的干预措施。