Cost-Effectiveness of Empagliflozin in Patients with Chronic Heart Failureand Chronic Kidney Disease: A Systematic Review

INTRODUCTION: To evaluate the cost-effectiveness of empagliflozin in patients with chronic heart failure with preserved ejection fraction (CHFpEF) and moderately reduced ejection fraction (CHFmrEF) across various healthcare systems. MATERIALS AND METHODS: A systematic review was conducted according to PRISMA 2024 guidelines. A total of 6 studies were included after screening 225 records from PubMed, Web of Science, ScienceDirect, and Google Scholar. Studies evaluating cost-effectiveness outcomes, including incremental cost-effectiveness ratios (ICER), quality-adjusted life years (QALY), and healthcare costs, were analyzed. RESULTS: All included studies applied a Markov model over a 10-year time horizon. Empagliflozin was associated with a 15-18% reduction in hospitalizations, an increase in QALYs by 0.11-0.67, and ICERs ranging from €5,089/QALY to $174,053/QALY, depending on the healthcare setting and model assumptions. Examples include: Spain: €5,089/QALY, China: $11,292/QALY, USA: $25,974-$174,053/QALY, Australia: A$29,202/QALY. ICER per life year (LY) ranged from $6,246 to $151,929, indicating variable cost-effectiveness based on country-specific cost structures and thresholds. CONCLUSIONS: Empagliflozin appears to be a cost-effective add-on therapy to standard care for CHFpEF and CHFmrEF, especially in healthcare systems with high hospitalization costs. However, its value is highly sensitive to drug pricing and national willingness-to-pay thresholds. Further real-world studies are needed to confirm long-term economic benefits. The review was registered with PROSPERO (CRD420250654439). Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD420250654439.

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