Medical Journal of the Islamic Republic Of Iran

en Economic Evaluation of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Heart Failure with Preserved or Mildly Reduced Ejection Fraction: A Systematic Review Health Management and Economics Health Management and Economics 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.   Cost-effectiveness, Cost-utility, Dapagliflozin, Empagliflozin, Heart failure 1446 1459 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-6393-2&slc_lang=en&sid=1 Mohsen Rezaeian moeygmr2@yahoo.co.uk 200319475328460095679 200319475328460095679 No Department of Epidemiology and Biostatistics, School of Health, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Mostafa Nasirzadeh mnasirzadeh13@yahoo.com 200319475328460095680 200319475328460095680 No Department of Health Education and Health Promotion, School of Health, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Mahsa Tashakori-Miyanroudi mhs_tashakori@yahoo.com 200319475328460095681 200319475328460095681 No Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran Aziz Rezapour rezapoor_a57@yahoo.com 200319475328460095682 200319475328460095682 No Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran Majid Hghjoo majid.haghjoo@gmail.com 200319475328460095683 200319475328460095683 No Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Aghdas Souresrafil asouresrafil@gmail.com 200319475328460095684 200319475328460095684 Yes Department of Health Services and Health Promotion, School of Health, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran