Dapagliflozin cost-effectiveness analysis in heart failure patients in Egypt.

AIMS: In Egypt, cardiovascular (CV) diseases are not only the cause of 33% of disability-adjusted life years but are also a leading cause of death. This study aimed to evaluate dapagliflozin's cost-effectiveness as an add-on to the standard of care (SOC) for the treatment of heart failure with reduced ejection fraction (HF-rEF) from the Egyptian healthcare system perspective. MATERIALS AND METHODS: A state transition model was utilized to assess the cost-effectiveness of dapagliflozin as an add-on to the SOC and a cost-minimization analysis was performed to compare dapagliflozin to sacubitril/valsartan, as they have had similar efficacy. Patients were stratified into four health states using the KCCQ-TSS, in addition to a CV and non-CV mortality health states. Urgent heart failure (HF) visits and hospitalizations were captured as transient states. Clinical parameters and baseline characteristics were based on the DAPA-HF trial, utility scores were extracted from published articles, and costs were derived from the Universal Health Insurance Authority national database. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The treatment costs of HF-rEF patients receiving dapagliflozin compared to SOC are 47,901EGP ($10,550) and 34,377EGP ($7,572), respectively. The quality-adjusted life-years (QALYs) of dapagliflozin compared to SOC are 4.57 and 4.20, respectively. This resulted in an incremental cost per effectiveness ratio (ICER) of 36,449EGP ($8,028) per QALY gained over the lifetime horizon, suggesting this is cost-effective. Results of the cost-minimization analysis showed cost savings where the annual costs of dapagliflozin vs. sacubitril/valsartan are 10,914EGP ($2,404) and 32,242EGP ($7,101), respectively. CONCLUSION: Dapagliflozin was found to be a highly cost-effective and cost-saving medication when compared to SOC and sacubitril/valsartan, respectively, in the treatment of HF-rEF from Egyptian healthcare system perspective. The ICER was below the willingness-to-pay threshold because dapagliflozin improved outcomes (less frequent hospitalization and mortality).

The atrial FibriLlatiOn real World management registry in the Middle East and Africa: design and rationale.

BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia, affecting 33.5 million patients globally. It is associated with increased morbidity, leading to significant clinical and economic burden. There exist only limited data in the Middle Eastern region from the existing registries. The goal of the FLOW-AF (atrial FibriLlatiOn real World management registry in the Middle East and Africa) registry is to evaluate the characteristics, treatment patterns, and clinical and economic outcomes associated with anticoagulation among patients newly diagnosed with nonvalvular atrial fibrillation in Egypt, Lebanon, the Kingdom of Saudi Arabia, and the United Arab Emirates. METHODS: This study will be a multicountry, multicenter, prospective observational registry aiming to enroll 1446 newly diagnosed nonvalvular atrial fibrillation patients at more than 20 sites across the four countries. During the recruitment period, patients will be included if they were newly diagnosed with nonvalvular atrial fibrillation and had initiated treatment for the prevention of stroke/systemic embolism. Patient data will be assessed prospectively at 6 and 12 months from their enrollment date. Demographics, clinical characteristics, antithrombotic treatments received, clinical outcomes, adverse events, healthcare resource utilization, and direct costs associated with management of nonvalvular atrial fibrillation will be collected and analyzed overall, by country, and by groups created based on treatment, demographics, and clinical characteristics, medical history and risk factors. CONCLUSION: The FLOW-AF registry will provide information on the uptake of oral anticoagulants, treatment patterns, clinical outcomes, and healthcare utilization and costs among newly diagnosed nonvalvular atrial fibrillation patients in the Middle Eastern region.

Stent for Life Initiative placed at the forefront in Egypt 2011.

AIMS: Myocardial infarction is a medical emergency in which 25 to 35% of patients will die before receiving medical attention. The Stent for Life registry was launched to access the current situation of the Egyptian population presenting with STEMI, and to determine what were the barriers to providing patients with cardiac problems appropriate care. METHODS AND RESULTS: This registry was conducted at 14 centres covered all the Egyptian regions including 1,324 consecutive patients presenting with STEMI during the period between January 1st, 2011 to November, 2011. Fourteen centres and 38 interventionalists participated in this registry; only six centres are Pilot Centres (fulfilling the criteria for a primary PCI centre) and were assigned at the end of 2011. Cardiovascular risk factors were mainly smoking (60.5%), dyslipidaemia (46.0%), diabetes (51.4%) and hypertension (56.0%). The mean age at presentation was 56.01±10.61years and 75.0% were male. Only 5% of the STEMI patients arrived via the emergency medical system. Thrombus aspiration was done in 42.7% of patients in primary PCI group and 25.9% in rescue PCI group. Bare metal stents (BMS) were used in 80.7% of the stented patients while drug eluting stents (DES) were used in 19.3% of the stented patients. In-hospital mortality was 2.9% (1.4% in primary PCI group, 1.1% in patients treated with thrombolysis and 0.4% in patients receiving no reperfusion therapy). CONCLUSION: Despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in our country, possibly similar to those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions.