Figure 3. Incremental Cost-effectiveness of Dapagliflozin in Treatment of Heart Failure With Reduced Ejection Fraction.

We varied the annual cost of dapagliflozin, holding all other input parameters at their base-case value. The different annual costs analyzed included: (1) Federal Supply Schedule (base case, $4192); (2) wholesale acquisition price ($6188); (3) the price obtained if the wholesale acquisition were discounted by 40% (average value of rebates and discounts on diabetes pharmaceuticals) ($3713); and (4) a heavily discounted net price at which dapagliflozin is available in some US markets ($953). The color quadrants indicate the annual cost at which adding dapagliflozin to guideline-directed medical therapy would be cost-effective relative to guideline-directed medical therapy alone at thresholds of $50 000, $100 000, and $150 000 per quality-adjusted life year (QALY) gained. These results permit health systems and clinicians to estimate the incremental cost-effectiveness of dapagliflozin for HFrEF in the context of their cost of a year’s supply of dapagliflozin.