Trends of health care costs of heart failure during implementation of SGLT2 inhibitors: Data from Finnish nationwide registers

Introduction Heart failure (HF) is costly to society due to the severity and high prevalence of the disease. While drug treatments are relatively affordable, the high costs of HF are often driven by resource-intensive hospital care. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may have potential to mitigate the disease burden and costs of both HF with reduced or preserved ejection fraction. Purpose There is a gap of evidence on how healthcare costs of HF have changed in the general population in the era of the introduction and implementation of SGLT2i into clinical practice. This study aimed to address to this gap. Methods We collected data on costs of all-cause medications, hospitalisations, outpatient visits and primary care visits from nationwide registers in Finland. All patients with new-onset or established HF, visiting and getting treated in Finnish hospital care between 2016 and 2022 were included. The index date was set to the first hospital visit with a primary diagnosis of heart failure (ICD-10: I.50) during the study period. Patients were followed from the index date to one year after the index date or death, which ever occurred first. Costs were stratified based on whether patients were dispensed a SGLT2i at any time during follow-up vs. those who were not. Age, sex and the Charlson-Quan comorbidity index were reported at the index date. Results A total of 163,166 patients with HF were included, of which 8,959 (5.5%) were dispensed an SLGT2i during follow-up and average time to first dispensation from index was 86 days (Q25: 10 days, median 44 days, Q75 126 days). The average age at diagnosis was 70.9 years and 34.7% of patients were female among the SGLT2i users, and 79.0 years and 53% female in the group without SGLT2i use. Patients were highly comorbid, with a Charlson-Quan comorbidity score of 3.33 and 3.15 on average among those with and without SGLT2i use, where chronic pulmonary disease and diabetes were the most common non-cardiovascular comorbidities. The average per-patient costs for those using SGLT2i decreased from €31,296 in 2016 to €28,433 in 2022. For those without SGLT2i use in the follow-up period the costs were € 37,419 and € 33,303 in 2016 and 2022, respectively (Figure 1). On average across all years, patients with SGLT2i had €4,581 lower per-patient costs than those not using SGLT2i. Hospitalisation costs accounted for 75.8% and 68.5% of all costs in those without and with SGLT2i use over the years and the SGLT2i group had on average €5,804 lower hospitalisation costs. Thus, lower hospitalisation costs were the main driver for the cost difference between two groups. Conclusions Healthcare costs of this nationwide cohort of HF patients decreased over time. This may indicate better and more optimised treatment of HF during the study period. Patients who received a SGLT2i during follow-up had on average lower cost than those who did not receive SGLT2i, driven by lower hospitalisation costs.