Key result
Early empagliflozin post-MI yields an incremental cost-effectiveness ratio of €45,100 per QALY gained.
Why the study?
Empagliflozin reduced heart failure hospitalizations after acute myocardial infarction without a mortality benefit, and its long-term economic value from the German statutory health insurance perspective was unknown.
Is early empagliflozin cost-effective compared to standard care for the prevention of heart failure in post-myocardial infarction patients at increased risk?
Is early empagliflozin cost-effective compared to standard care for the prevention of heart failure in post-myocardial infarction patients at increased risk?
Effect estimate: ICER €45,100/QALY
Absolute Event Rate: 8.352% vs 8.321%
Early initiation of empagliflozin after acute myocardial infarction offers modest long-term health gains at higher costs, with economic value heavily dependent on drug pricing, absolute baseline risk, and structural assumptions regarding chronic heart failure prevention.
Background and objective Empagliflozin reduced heart failure (HF) hospitalizations after acute myocardial infarction (MI) in EMPACT-MI without a mortality benefit. We assessed whether HF morbidity prevention generates long-term economic value from the German statutory health insurance perspective. Methods We developed a monthly cohort Markov model over a lifetime horizon comparing early empagliflozin plus standard care with standard care in post-MI patients at increased HF risk. The base case applied the EMPACT-MI hazard ratio of 0.77 for first HF hospitalization, assumed no direct mortality benefit, and modelled 24 months of treatment. Costs were in 2026 euros. The primary analysis covered 17.9 months; exploratory lifetime outcomes included quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Results Early empagliflozin gained 0.0315 QALYs at €1,418 incremental cost (ICER €45,100/QALY) and avoided 52.0 lifetime HF hospitalizations per 1000 patients. The probability of cost-effectiveness was 16.2%, 55.2%, and 79.7% at €30,000, €50,000, and €80,000/QALY, respectively. Price reductions of 25% and 50% lowered the ICER to €32,300/QALY and €19,500/QALY. The maximum annual price compatible with €30,000/QALY was €607. Results were most sensitive to the HF hospitalization effect, drug price, and baseline HF risk. A trial-anchored analysis using the EMPACT-MI placebo event and mortality rates yielded a similar ICER (€47,200/QALY). Conclusions Early empagliflozin generated modest projected QALY gains, predominantly through modelled indirect survival gains, at higher lifetime costs.Economic value was conditional, depending on willingness-to-pay, net price, and absolute HF risk, with the most favorable profile at lower net prices and in HF-risk-enriched patients.
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Boettger et al. (2026) studied Acute myocardial infarction at increased risk of heart failure. Empagliflozin vs. Standard post-myocardial infarction care was evaluated on Incremental cost per quality-adjusted life-year (QALY) gained (ICER €45,100/QALY). Early empagliflozin gained 0.0315 quality-adjusted life-years at an incremental cost of €1,418 compared to standard care, resulting in an incremental cost-effectiveness ratio of €45,100 per QALY.
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