Differential uptake of SGLT2 inhibitors in England following heart failure guideline expansion: a controlled interrupted time series analysis
Abstract
Abstract Objectives To assess differential changes in prescribing uptake of dapagliflozin and empagliflozin relative to canagliflozin in England following the July 2023 expansion of heart failure guideline recommendations. Design Controlled interrupted time series (ITS) analysis using segmented regression with Newey-West SEs and month fixed effects to account for seasonality. Setting and participants National monthly primary care prescribing data in England (January 2019–December 2025). Aggregate prescribing data were analysed at the drug level. Primary and secondary outcome measures Primary outcome: monthly utilisation measured in defined daily doses (DDDs). Secondary outcomes: monthly prescription items, market share of total SGLT2 inhibitor DDDs and net ingredient cost (NIC). Results Overall utilisation increased for all three monotherapy SGLT2 inhibitors, but prescribing trajectories diverged markedly following the intervention. Dapagliflozin’s market share rose from 33.2% to 55.9%, while empagliflozin declined to 41.0% and canagliflozin to 3.1%. The controlled ITS model showed no immediate step change at July 2023. However, dapagliflozin demonstrated a significant differential postintervention slope increase relative to canagliflozin (β=0.042, 95% CI 0.035 to 0.049; p<0.001), corresponding to an additional 4.3% monthly growth. Empagliflozin showed a smaller but significant relative increase (β=0.015, 95% CI 0.008 to 0.022; p<0.001). Counterfactual analysis estimated…
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