The 2019 ADA’s Standards of Medical Care in Diabetes recommends use of SGLT2 inhibitor (SGLT2i) or GLP-1 receptor agonist (GLP-1RA) as one of the six drug classes after metformin (MET) in T2D patients, and is recommended as the treatment of choice among patients with cardiovascular disease (CVD; empagliflozin [EMPA] and liraglutide showing stronger evidence). To understand the economic impact of these recommendations, we evaluated the effect of EMPA vs. GLP-1 RA initiation on all-cause (AC) healthcare costs in patients with T2D. This retrospective cohort study utilized an U.S. commercial claims database to identify patients with T2D who newly initiated EMPA or a GLP-1RA between 08/2014 - 12/2016. First prescription date (index date) for EMPA or a GLP-1RA was used to classify patients into respective cohorts. T2D diagnosis and baseline covariates were assessed during 1-year pre-index period. During a post-index period of up to 1 year, AC costs were computed on a per patient per month (PPPM) basis; and evaluated using generalized linear models that controlled for pre-index covariates. Compared to the GLP-1RA cohort (N = 13,216), patients in the EMPA cohort (N= 3,857) were younger, more likely to be male, and had lower rates of obesity in the 1-year baseline period; all other measured pre-index covariates were similar. After covariate adjustment, the adjusted total AC PPPM cost difference ($1,137 vs. $1,370; difference (Δ) = -$233 PPPM) remained significantly lower for the EMPA cohort (P<0.001), as compared to GLP-1 RA cohort. Both medical (Δ = -$26 PPPM, p=0.06), and pharmacy (Δ = -$197 PPPM, p<0.001) costs were lower in EMPA cohort, as compared to GLP-1 RA cohort. Use of empagliflozin vs. GLP-1 RA in T2D patients was associated with lower all-cause healthcare costs. Together with ADA guidelines, these findings can aid health care stakeholders in treatment decisions and optimizing clinical and economic outcomes for patients with T2D.


P. Pimple: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Employee; Spouse/Partner; CVS Caremark. A. Raju: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb. D. Stafkey-Mailey: None. S. Shetty: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.

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