Cost-effectiveness of early empagliflozin initiation after acute myocardial infarction: a German statutory health insurance perspective

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).