Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Addition to Standard Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis
4
Issued Date
2026-01-01
Resource Type
ISSN
10983015
eISSN
15244733
Scopus ID
2-s2.0-105037949116
Pubmed ID
41962835
Journal Title
Value in Health
Rights Holder(s)
SCOPUS
Bibliographic Citation
Value in Health (2026)
Suggested Citation
Tongpoonsakdi N., Tansawet A., Yingchoncharoen T., Amornritvanich P., Noviyani R., Thavorncharoensap M., McKay G.J., Attia J., Thakkinstian A. Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Addition to Standard Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis. Value in Health (2026). doi:10.1016/j.jval.2026.03.2233 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116705
Title
Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Addition to Standard Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Guideline-directed medical therapies (GDMTs) have improved heart failure (HF) outcomes, particularly with the emergence of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNI). However, their cost-effectiveness remains uncertain across HF phenotypes, income levels, and analytic perspectives. Objectives: The study aimed to evaluate and compare the incremental net benefit (INB) of SGLT2i and/or ARNI added to traditional GDMTs, stratified by HF phenotype, country income level, and study perspective. Methods: PubMed, Scopus, and the Cost-Effectiveness Analysis Registry were searched through October 2024. Economic evaluations assessing SGLT2i or ARNI added to traditional GDMTs were included. INBs and variances were extracted or calculated; if unavailable, variances were imputed via regression or based on similar studies. Random-effects meta-analyses were performed by treatment-comparator pairs, HF phenotype, income level, and perspective. Risk of bias was assessed using the Bias in Economic Evaluation checklist. Results: Seventy studies were included. Adding SGLT2i to traditional GDMTs was cost-effective in high-income countries (HICs) for HF with reduced ejection fraction (HFrEF) from healthcare perspective (pooled INB = US $13 114.52; 95% CI: 4257.40–21 971.63), whereas evidence was inconclusive for upper-middle (UMICs) or lower-income countries. Quadruple regimen (SGLT2i + ARNI) appeared cost-effective in HICs and UMICs, although evidence was limited. Replacing other renin-angiotensin-aldosterone system blockers with ARNI was only cost-effective for HFrEF from societal perspective in HICs (INB = US $14 843.66; 95% CI: 566.36–29 120.96). Evidence for other HF phenotypes remained inconclusive evidence. Conclusions: Adding SGLT2i and ARNI improves GDMTs cost-effectiveness for the treatment of HFrEF, especially in HICs. More evidence is needed for other HF types and income settings.