Background: The ADA’s “Standards of Medical Care in Diabetes” recommends use of an SGLT2 inhibitor or GLP-1 receptor agonist as one of the six drug classes after metformin (MET) in T2D patients. These therapies are preferred among T2D patients with cardiovascular disease (CVD) based on clinical trial results demonstrating significant improvement in clinical outcomes. We sought to examine the economic implications of sequential use of these therapies.
Methods: An economic simulation model evaluating treatment in U.S. T2D patients after MET with empagliflozin (EMPA) as 2nd line and liraglutide (LIRA) as 3rd line vs. LIRA as 2nd line and EMPA as 3rd line was used to estimate the lifetime health and cost outcomes of T2D-related complications and adverse events (AEs). Complications, including CV death, myocardial infarction, stroke, and renal outcomes, were predicted using United Kingdom Prospective Diabetes Study risk equations and EMPA-REG OUTCOME data. A meta-analysis informed treatment-induced changes in HbA1c, SBP, and weight in patients without CVD. For each complication in patients with CVD, an indirectly estimated hazard ratio of LIRA vs. EMPA was applied. Costs ($2019), AE rates, and utilities were sourced from published literature.
Results: Compared with LIRA as 2nd line, use of EMPA added 0.32 quality-adjusted life-years (QALYs) and led to lower lifetime costs (by $11,422/patient), suggesting dominance over 2nd line LIRA (improved health outcomes at lower cost). These results were similar across CVD subgroups. Patients with CVD at baseline compared to those without CVD showed larger gains in incremental QALYs (0.42 with CVD, 0.29 without CVD) with somewhat lower cost savings (by $9,550, $12,392, respectively) for 2nd line EMPA vs. LIRA, showing dominance in both subpopulations.
Conclusion: For T2D patients with and without CVD, the use of EMPA on background MET was a dominant strategy for U.S. payers, associated with improved outcomes and lower costs as compared with LIRA.
O. Reifsnider: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. P. Pimple: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Employee; Spouse/Partner; CVS Caremark. M.J.D. Stargardter: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. S. Brand: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. N. Desai: None. S. Shetty: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.
