Sacubitril/valsartan versus in empagliflozin heart failure with preserved ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) is associated with frequent hospitalizations and an increased risk of death. Empagliflozin was recently reported to reduce the combined risk of cardiovascular death or hospitalization for heart failure (HF) among patients with HFpEF, whereas Sacubitril/Valsartan has shown only marginal significance benefits in these patients. We aimed to compare the value for money of these treatments. Methods We compared the annualized Cost Needed to Treat (CNT) to prevent the composite outcome of HF hospitalization and cardiovascular death with Empagliflozin or Sacubitril/Valsartan. The CNT was estimated by multiplying the drug-specific annual cost and the annualized Number Needed-to-Treat (aNNT) which was calculated based on data from the EMPEROR-Preserved and PARAGON -HF trials for Empagliflozin and Sacubitril-Valsartan, respectively. Costs were based on 2021 US prices. We performed scenario analyses to attenuate the differences between the studies’ populations. Subgroup analyses were performed across diabetes status. Results The aNNT with Empagliflozin in EMPEROR-Preserved was 61 (95% CI: 41-128) versus 53 (28-∞) with Sacubitril-Valsartan in PARAGON-HF, with an annual cost of 4,797$ versus 6,298 $, respectively. The corresponding CNTs were therefore $292,620 (95% CI: 196,679 - 614,023) for Empagliflozin and $333,834 (95% CI: 176,365 - ∞) for Sacubitril-Valsartan. In diabetic patients, the corresponding CNTs were $254,244 (95% CI: 158,303 - 882,659) for Empagliflozin versus $308,639 (95% CI: 132, 2740 - ∞) for Sacubitril-Valsartan. In non-diabetic patients, the corresponding CNTs were $326,200 (95% CI: 201,476 - 1,443,914) for Empagliflozin versus $333,834 (170,066 - ∞) for Sacubitril-Valsartan. Conclusion Empagliflozin provides better value for money than Sacubitril-Valsartan in preventing HF hospitalizations and cardiovascular death among patients with HFpEF. This difference was more pronounced among patients with diabetes.