May 27, 2021 Adding dapagliflozin to standard heart failure therapies provides “intermediate value” for American patients who have heart failure with reduced ejection fraction (HFrEF), a new cost-effectiveness analysis suggests—at odds with earlier analyses that suggested the cost per quality-adjusted life-year (QALY) would be below the accepted $50,000 cutoff. That’s because earlier studies, focused on settings outside the United States, considered both the “markedly lower” costs of the drug in countries like the United Kingdom, Germany, and Spain, as well as the lower overall healthcare costs in those nations, investigators led by Justin Parizo, MD (Stanford University, CA), say. “Cost-effectiveness analyses are inherently tied to the society in which they’re evaluated,” senior author Alexander Sandhu, MD (Stanford University), explained to TCTMD. “While the clinical benefits might be quite similar across different contexts and populations, the costs of therapy and the costs of chronic care can vary substantially, so in order to be relevant to a decision maker in a given country, that context and those costs have to be taken into account. That's why it’s important to have country-specific cost-effectiveness estimates of therapy, specifically to help healthcare systems and payers understand relative value and the need for investment in important therapies like dapagliflozin.”