Dapagliflozin kosteneffectief bij chronisch hartfalen — economische evaluatie in Argentinië

BACKGROUND: Heart failure is associated with high morbidity, mortality, and substantial resource use. Dapagliflozin improves outcomes in heart failure, but local economic evidence for Argentina is limited. We conducted a cost-utility analysis of dapagliflozin added to standard therapy for chronic heart failure in Argentina. METHODS: We conducted a cost-utility analysis from the Argentine public health system perspective using two trial-based Markov models (DAPA-HF and DELIVER populations), monthly cycles, lifetime horizon, and 3% annual discounting for costs and outcomes. Inputs were derived from published trial data and Argentine sources where available. We estimated costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), and performed deterministic and probabilistic sensitivity analyses. FINDINGS: In the DAPA-HF model, dapagliflozin increased QALYs by 0.76 with an incremental cost of US$5069, yielding an ICER of US$6672 per QALY. In the DELIVER model, dapagliflozin increased QALYs by 0.44 with an incremental cost of US$4542, yielding an ICER of US$10,371 per QALY. At a willingness-to-pay threshold of 1 gross domestic product (GDP) per capita, the probability of cost-effectiveness was 97% (DAPA-HF) and 73% (DELIVER). INTERPRETATION: Dapagliflozin added to standard therapy is likely to be cost-effective in Argentina, with greater robustness in heart failure with reduced ejection fraction. In preserved or mildly reduced ejection fraction, cost-effectiveness is compatible with a 1 GDP per capita threshold but more sensitive to key assumptions; price negotiation could improve value for money. FUNDING: None.