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We assessed whether HF morbidity prevention generates long-term economic value from the German statutory health insurance perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Early empagliflozin gained 0.0315 QALYs at \u20ac1,418 incremental cost (ICER \u20ac45,100\/QALY) and avoided 52.0 lifetime HF hospitalizations per 1000 patients. The probability of cost-effectiveness was 16.2%, 55.2%, and 79.7% at \u20ac30,000, \u20ac50,000, and \u20ac80,000\/QALY, respectively. Price reductions of 25% and 50% lowered the ICER to \u20ac32,300\/QALY and \u20ac19,500\/QALY. The maximum annual price compatible with \u20ac30,000\/QALY was \u20ac607. Results were most sensitive to the HF hospitalization effect, drug price, and baseline HF risk. A trial-anchored analysis using the EMPACT-MI placebo event and mortality rates yielded a similar ICER (\u20ac47,200\/QALY).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early empagliflozin generated modest projected QALY gains, predominantly through modelled indirect survival gains, at higher lifetime costs.Economic value was conditional, depending on willingness-to-pay, net price, and absolute HF risk, with the most favorable profile at lower net prices and in HF-risk-enriched patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12962-026-00830-0","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T09:44:04Z","timestamp":1791193444000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of early empagliflozin initiation after acute myocardial infarction: a German statutory health insurance perspective"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0534-132X","authenticated-orcid":false,"given":"Priyanka","family":"Boettger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Nakou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kinsley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Buerke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva-Maria","family":"Wild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"1","key":"830_CR1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/BF03321561","volume":"3","author":"SN Willich","year":"2005","unstructured":"Willich SN, et al. 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No individual patient-level data were used; therefore, ethics approval was not required.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This manuscript does not contain individual person data, images, or other identifiable material.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This study did not involve individual human participants or individual patient-level data.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During manuscript preparation, Microsoft Copilot was used to assist with language polishing and grammatical refinement. No AI tool was used for data analysis, interpretation, or generation of scientific content. The authors critically reviewed and approved the final manuscript.","order":4,"name":"Ethics","label":"Declaration of AI-assisted technologies","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"123"}}