Cost-Effectiveness Analysis of Empagliflozin in Comparison to Sitagliptin and Saxagliptin Based on Cardiovascular Outcome Trials in Patients with Type 2 Diabetes and Established Cardiovascular Disease

Abstract

IntroductionIn the cardiovascular outcome trials (CVOT) EMPA-REG OUTCOME, TECOS and SAVOR-TIMI 53, empagliflozin [sodium/glucose cotransporter 2 (SGLT2) inhibitor], sitagliptin and saxagliptin [both dipeptidyl peptidase 4 (DPP4) inhibitors] + standard of care (SoC) were compared to SoC in patients with type 2 diabetes and established cardiovascular disease (CVD). This study assessed the cost-effectiveness (CE) of empagliflozin + SoC in comparison to sitagliptin + SoC and saxagliptin + SoC based on the respective CVOT.MethodsThe IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the CVOT outcomes. EMPA-REG OUTCOME baseline characteristics and CVOT specific treatment effects on risk factors for cardiovascular disease [glycated haemogloblin A1c (HbA1c), body mass index (BMI), blood pressure, lipids] were applied. Three-year observed cardiovascular events of empagliflozin + SoC versus sitagliptin + SoC and saxagliptin + SoC were derived from EMPA-REG OUTCOME and an indirect treatment comparison. Relative risk (RR) adjustments to calibrate the CDM were estimated after consecutive attempts of running the model until the observed and CDM-predicted outcomes matched closely. The drug-specific treatment effects were considered up until treatment switch (when HbA1c reached 8.5%), after which, the United Kingdom Prospective Diabetes Study (UKPDS) 82 risk equations predicted events based on co-existing risk factors and treatment intensification to basal-bolus insulin were applied. The analysis was conducted from the perspective of the UK National Health Service. Costs and quality of life data were derived from UK national sources and published literature. A 50-year time horizon and discount rate of 3.5% were applied.ResultsThe CDM projected quality-adjusted life years (QALYs) of 6.408, 5.917 and 5.704 and total costs of 50,801 GBP, 47,627 GBP and 48,071 GBP for empagliflozin + SoC, sitagliptin + SoC and saxagliptin + SoC, respectively. The incremental CE ratio (ICER) of empagliflozin + SoC versus sitagliptin + SoC and saxagliptin + SoC was 6464 GBP/QALY and 3878 GBP/QALY, respectively. One-way and probabilistic sensitivity analyses demonstrated the robustness of the results.ConclusionResults suggest that empagliflozin + SoC is cost-effective compared to sitagliptin + SoC and saxagliptin + SoC at a willingness to pay threshold of 20,000 GBP/QALY.FundingBoehringer Ingelheim International GmbH.Electronic supplementary materialThe online version of this article (10.1007/s13300-019-00701-3) contains supplementary material, which is available to authorized users.

Current trends in diabetes mellitus database research in Japan

“…In addition, given the recent increase in diabetes incidence at a younger age due to lifestyle changes, 114 the actual earnings and expenses affected by the reduction or cessation of work productivity should also be evaluated. In parallel with several successful RCT results showing a risk reduction of cardiovascular and renal events with SGLT2i in patients with T2DM, several studies using a simulation model suggested better cost‐effectiveness of SGLT2i compared to that of non‐SGLT2i treatment when used in addition to the standard of care 115–121 . Moreover, an observational study using a database in the US and Sweden demonstrated lower healthcare costs of SGLT2i initiation compared to those of DPP4‐i or other non‐SGLT2i treatments 122,123 .…”

Sodium glucose cotransporter 2 inhibitors: mechanisms of action in heart failure

“…The study demonstrated that empagliflozin plus standard care is a cost-effective treatment compared with only standard care and was considered dominant versus liraglutide plus standard care in the management of patients with both diabetes and confirmed CVD [ 45 ]. In other health economic studies based on the EMPA-REG OUTCOME trial, it has also been confirmed that empagliflozin therapy is cost-effective in patients with both diabetes and confirmed CVD [ 46 – 48 ].…”

Cost‐effectiveness analysis of empagliflozin versus sitagliptin as second‐line therapy for treatment in patients with type 2 diabetes in the United States

“…Previous treatment‐sequence cost‐effectiveness analyses in T2D have been reported, although not with sequences that compared empagliflozin with sitagliptin 27,28 . In a previous analysis that did compare empagliflozin plus standard of care (SoC) with sitagliptin plus SoC, sequences were not considered and only patients with established CVD were modelled 29 . Nonetheless, similar trends were observed in that study, as empagliflozin plus SoC was found to be cost‐effective compared with sitagliptin plus SoC (£6464/QALY) 29 .…”

“…In a previous analysis that did compare empagliflozin plus standard of care (SoC) with sitagliptin plus SoC, sequences were not considered and only patients with established CVD were modelled 29 . Nonetheless, similar trends were observed in that study, as empagliflozin plus SoC was found to be cost‐effective compared with sitagliptin plus SoC (£6464/QALY) 29 . In another study, although a comparison of empagliflozin and sitagliptin was not presented, the absolute cost and QALY results indicate that empagliflozin is cost‐effective versus sitagliptin (an ICER of $37 500/QALY was calculated based on the reported results) 30 .…”