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Heart Failure Treatment and Management / Diabetes Treatment and Management · Journal article
European Journal of Heart Failure · July 15, 2026
Well-designed and adequately powered for the question it asks.
This network meta-analysis of 47 RCTs synthesises efficacy and cost-effectiveness evidence for pharmacological HFrEF treatments, finding quadruple therapy (ARNI+BB+MRA+SGLT2i) to be the most cost-effective strategy with a net monetary benefit of £338,460 and 12.31 QALYs gained in the UK healthcare context. Findings were replicated in Swedish and US healthcare systems, suggesting robustness to economic setting.
Network meta-analysis of randomized controlled trials with integrated cost-effectiveness analysis. Patients with heart failure with reduced ejection fraction from RCTs evaluating guideline-directed medical treatments.. Intervention: Quadruple pharmacological therapy: ARNI + β-blocker + mineralocorticoid receptor antagonist + SGLT2 inhibitors, and other combination regimens. Compared with: Various pharmacological treatment strategies, including lower-intensity combinations. n = 75,978. United Kingdom (main analysis); Sweden and United States (scenario analyses).
47 RCTs with 75,978 patients included in the network meta-analysis Risk of all-cause mortality and total HF hospitalizations decreased with increasing number of pharmacological treatments Quadruple therapy (ARNI+BB+MRA+SGLT2i) achieved 12.31 quality-adjusted life-years in UK analysis
Risk of all-cause mortality and total HF hospitalizations decreased with increasing number of pharmacological treatments
This economic analysis supports the use of quadruple combination therapy as the preferred cost-effective strategy for HFrEF across multiple healthcare systems, informing treatment selection and reimbursement decisions. Clinicians should consider affordability, budget impact, and implementation feasibility alongside cost-effectiveness evidence when applying these findings to individual patients.
Network meta-analysis of 47 RCTs with 75,978 patients synthesizing efficacy and cost-effectiveness data across multiple healthcare systems, demonstrating quadruple therapy as superior strategy with quantified health economic outcomes.
As stated by the source record.
Quoted from the source exactly as published.
This economic analysis supports the use of quadruple combination therapy as the preferred cost-effective strategy for HFrEF across multiple healthcare systems, informing treatment selection and reimbursement decisions. Clinicians should consider affordability, budget impact, and implementation feasibility alongside cost-effectiveness evidence when applying these findings to individual patients.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND AND AIMS: To assess the cost-effectiveness of guideline-directed medical treatments for heart failure with reduced ejection fraction (HFrEF) by performing a network meta-analysis (NMA) of randomized controlled trials (RCTs) feeding a subsequent cost-effectiveness analysis. METHODS: A random-effects NMA of RCTs was conducted. The primary analysis included only RCTs evaluating drugs in the clinical settings as recommended in the 2021 European Society of Cardiology HF guidelines. Main efficacy outcomes included all-cause mortality (ACM) and total HF hospitalizations (HFH). A decision tree-Markov model was populated with NMA-derived efficacy estimates, quality-of-life data, and costs from United Kingdom (UK, main analysis), as well as Sweden and United States (US) (scenario analyses) healthcare perspectives. RESULTS: 47 RCTs (75,978 patients) were included. The risk of ACM and total HFH decreased with increasing number of pharmacological treatments. In the main (UK) analysis, the greatest benefit was observed with a quadruple therapy including angiotensin receptor-neprilysin inhibitor (ARNI) + β-blocker (BB) + mineralocorticoid receptor antagonist (MRA) + sodium-glucose cotransporter 2 inhibitors (SGLT2i), which resulted as the most cost-effective strategy (12.31 quality-adjusted life-years; net monetary benefit of £338,460; UK perspective). Findings were consistent in Sweden and US. CONCLUSION: Quadruple therapy with ARNI+BB+MRA+SGLT2i had the highest probability of being the most cost-effective strategy. Our findings might inform future health economic policies and reimbursement decisions, while also considering affordability, budget impact, and implementation feasibility.
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