Cost-effectiveness of Empagliflozin in Chronic Heart Failure: A Markov Model-based Analysis in Uzbekistan
Nargiza Sultanbayeva, Shakhnoz Umarova, Shokhista Iskandarova, Guzal Mullabaeva, Shohista MukhamedovaIntroduction:
Chronic Heart Failure (CHF) is a major public health challenge associated with high morbidity, mortality, and healthcare costs. Empagliflozin has demonstrated clinical benefits across the spectrum of heart failure; however, evidence on its economic value in low- and middle-income countries remains limited. To evaluate the cost-effectiveness of adding empagliflozin to standard therapy for patients with chronic heart failure from the perspective of the healthcare payer.
Materials and Methods:
A cohort-based Markov model with a 3-month cycle length and a 20- year time horizon was developed to simulate disease progression in CHF. Health states included no complications, cardiovascular complications, renal complications, and death. Outcomes were measured in Life Years (LYs), Quality-Adjusted Life Years (QALYs), total costs, and Incremental Cost-Effectiveness Ratios (ICERs). Both deterministic and probabilistic sensitivity analyses were conducted.
Results:
Quality-adjusted life expectancy increased from 11.595 to 12.224 QALYs. Total discounted costs were 48,133,588 UZS for empagliflozin versus 43,261,361 UZS for standard therapy. The Incremental Cost-Effectiveness Ratio (ICER) was 7,738,951 UZS per QALY gained, which was substantially below the national willingness-to-pay threshold of 141.6 million UZS.
Discussions:
Since the ICER for empagliflozin compared with placebo is substantially lower than the calculated willingness-to-pay threshold, empagliflozin can be considered a costeffective treatment option.
Conclusions:
Adding empagliflozin to standard therapy for CHF is a cost-effective intervention in the Republic of Uzbekistan and provides meaningful clinical and economic benefits.