Is Using Sodium-Glucose Cotransporter-2 Inhibitors to Treat Adults with Chronic Heart Failure Cost-Effective? A Systematic Review of Cost-Effectiveness Studies.

OBJECTIVE: This systematic review aimed to summarise the outcomes of economic evaluations that evaluated sodium-glucose cotransporter-2 inhibitors (SGLT2i) in combination with standard of care compared to standard of care alone for patients with chronic heart failure. METHODS: This systematic review searched MEDLINE, CINAHL+, Econlit, Scopus, the Cochrane Library, the National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry from inception to 31 December, 2022, for relevant economic evaluations, which were critically appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Bias in Economic Evaluation (ECOBIAS) criteria. The costs, quality-adjusted life-years, incremental cost-effectiveness ratios and cost-effectiveness thresholds were qualitatively analysed. Net monetary benefits at different decision thresholds were also computed. Subgroup analyses addressing the heterogeneity of economic outcomes were conducted. All costs were adjusted to 2023 international dollar (US$) values using the CCEMG-EPPI-Centre cost converter. RESULTS: Thirty-nine economic evaluations that evaluated dapagliflozin and empagliflozin in patients with heart failure were found: 32 for the left ventricular ejection fraction (LVEF) ≤ 40% and seven for LVEF > 40%. Sodium-glucose cotransporter-2 inhibitors were cost-effective in all but two economic evaluations for LVEF > 40%. Economic outcomes varied widely, but favoured SGLT2i use in LVEF ≤ 40% over LVEF > 40% and upper-middle income over high-income countries. At a threshold of US$30,000/quality-adjusted life-year, ~ 90% of high to upper-middle income countries would consider SGLT2i cost-effective for heart failure treatment. The generalisability of study findings to low- and low-middle income countries is limited because of insufficient evidence. CONCLUSIONS: Using SGLT2i to treat heart failure is cost-effective, with more certainty in LVEF ≤ 40% compared to LVEF > 40%. Policymakers in jurisdictions where economic evaluations are not available could potentially use this study's findings to make informed decisions about treatment adoption. SYSTEMATIC REVIEW PROTOCOL REGISTRATION: This study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023388701).

Eye drop instillation technique among patients with glaucoma and evaluation of pharmacists' roles in improving their technique: an exploratory study.

OBJECTIVES: This study aimed to explore the eye drop instillation technique of patients with glaucoma and whether a pharmacist-led counselling session can improve their technique. Patients' perceptions of pharmacists' role in providing the counselling were also explored. METHODS: This cross-sectional study was conducted between December 2020 and March 2021 at Sarawak General Hospital, Malaysia. Convenience sampling was used to recruit patients with glaucoma who self-administered their eye drops. Participants' background information were obtained using an investigator-administered questionnaire before their eye drop instillation technique was assessed. Those with imperfect techniques were counselled by a pharmacist before being reassessed. Differences in eye drop instillation competency were determined using paired T-test. KEY FINDINGS: A total of 138 participants were recruited. Participants were on a median of two eye drops (IQR 2-4) for a median of five years (IQR 2-8). Prior to being counselled, they demonstrated a mean total of 8.4/13 steps (SD 2.33) correctly. A statistically significant improvement in eye drop instillation technique was observed post-pharmacists' counselling, with a mean increase of 4.3 steps demonstrated correctly (95% CI, 4.0 to 4.7, P < 0.001). The majority of participants agreed that pharmacists are knowledgeable in providing counselling on eye drop administration techniques. CONCLUSIONS: Patients with glaucoma treated at Sarawak General Hospital had imperfect eye drop instillation techniques, despite most having used their eye drops for several years. Interventions by pharmacists to improve eye drop instillation are crucial to optimise the medical treatment of patients with glaucoma.