Evaluating the budget impact of Empagliflozin in managing heart failure with reduced ejection fraction: Proposing strategic policies for Malaysian public healthcare

• Published in: PloS one Vol. 19; no. 10; p. e0313131
• Main Authors: Yong, Vee Sim, Raman, Sivaraj, Yen, Chia How, Bahari, Mohd Shahri, Zaimi, Nur Amalina, Liew, Houng Bang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.10.2024
• Subjects: Benzhydryl Compounds - economics; Benzhydryl Compounds - therapeutic use; Beta blockers; Budget; Budgets; Cardiology; Clinical outcomes; Clinical practice guidelines; Congestive heart failure; Cost assessments; Costs; Dapagliflozin; Developed countries; Diabetes; Diabetes mellitus; Diabetics; Drug dosages; Ejection fraction; Expenditures; Failure; Fatalities; Female; Glucose transporter; Glucosides - economics; Glucosides - therapeutic use; Health care; Health Care Costs; Heart failure; Heart Failure - drug therapy; Heart Failure - economics; Humans; Impact analysis; Malaysia; Male; Market shares; Medical care, Cost of; Medicine and Health Sciences; Mortality; Patient compliance; Patients; People and Places; Pharmacoeconomics; Population studies; Public Health - economics; Quality of life; Research and Analysis Methods; Risk groups; Sensitivity analysis; Social Sciences; Sodium; Sodium-Glucose Transporter 2 Inhibitors - economics; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stroke Volume - drug effects; Task forces; Malaysia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0313131

Sodium-glucose co-transporter-2 (SGLT2) inhibitors such as Empagliflozin, are increasingly recommended as part of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in many developed nations. This recommendation is based on robust clinical evidence showing that adding Empagliflozin to GDMT improves heart failure symptoms, clinical outcomes, functional status, and overall quality of life. In Malaysia, where healthcare is predominantly public and heavily subsidized, the introduction of new treatments can significantly impact costs, requiring detailed economic assessments. This study evaluates the budget impact of incorporating Empagliflozin into GDMT for HFrEF from the perspective of the public healthcare system. A five-year budget impact model was developed, integrating local data such as population, drug use, costs, clinical outcomes, and healthcare expenses. In the current scenario (GDMT alone), the projected five-year expenditure is MYR 6.12 billion (USD 3.92 billion). With Empagliflozin, the total cost rises by 0.71% to MYR 6.16 billion (USD 3.95 billion), driven by drug acquisition costs of MYR 160.12 million (USD 102.64 million) and adverse event costs of MYR 211,543 (USD 135,604). However, these costs are offset by savings from reduced HF hospitalizations, fewer cardiovascular deaths, and improved renal outcomes. Sensitivity analysis identified hospitalization costs, the price of Empagliflozin, and cardiovascular deaths in diabetic patients as key factors influencing the budget impact. Policymakers can improve the affordability of Empagliflozin through strategies like price negotiations, cost-sharing, and focusing on high-risk groups to optimize healthcare expenditure while ensuring effective treatment access.