Economic Evaluation of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Heart Failure with Preserved or Mildly Reduced Ejection Fraction: A Systematic Review.

Background: Heart Failure (HF) is a complex and life-threatening syndrome with substantial morbidity, mortality, diminished function, and high healthcare costs. Several studies have demonstrated that sodium-glucose co-transporter 2 inhibitors (SGLT2i) are very promising for improving HF outcomes in patients with preserved ejection fraction (HFpEF) or mild reduction in ejection fraction (HFmrEF). A review of the cost-effectiveness of SGLT2 inhibitors for the treatment of HFpEF is essential to help clinicians and decision-makers identify the most cost-effective treatment option for HF. The purpose of this study was to review economic studies on the addition of SGLT-2i to HFpEF or HFmrEF. Methods: In this systematic review, searches were conducted across PubMed, Scopus, Web of Science, and EMBASE databases from January 2020 to March 2025. Full economic evaluations of adding SGLT-2i in HF with HFpEF or HFmrEF were included for data extraction. Articles were screened at the title, abstract, and full-text levels. The data were extracted into an Excel table, and the narrative synthesis was performed. The quality of the studies was assessed using the CHEERS 2022 criteria. Results: A total of 421 references were screened after removing duplicates. Twenty-one studies were identified that examined full economic evaluations of adding SGLT-2i in HFpEF or HFmrEF. Most studies were from China and the USA. The highest and lowest incremental costs per quality-adjusted life year for empagliflozin were in China ($10961.971) and the United States ($48,527.33) (healthcare system perspective). In most countries except Thailand, empagliflozin or dapagliflozin plus standard care (SoC) is more cost-effective than SoC alone in patients with HFpEF or HFmrEF. Conclusion: Study results indicate that adding SGLT2i to SoC is cost-effective in patients with HFpEF or HFmrEF. Moreover, further studies comparing dapagliflozin and empagliflozin in this patient group are needed.