Cost‐effectiveness analysis of empagliflozin treatment in people with Type 2 diabetes and established cardiovascular disease in the <scp>EMPA</scp>‐<scp>REG OUTCOME</scp> trial

Kansal, Anuraag R.; Reifsnider, Odette; Proskorovsky, Irina; Zheng, Ying; Pfarr, Egon; George, Jyothis T.; Kandaswamy, P.; Ruffolo, A.

doi:10.1111/dme.14076

Cited by 32 publications

(49 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using a participant-level simulation model and United Kingdom health care costs, empagliflozin in addition to standard of care is projected to be cost-effective. 101 The model predicted that although patients would incur increased out-ofpocket cost, empagliflozin in addition to standard of care would result in longer survival by 2.1 life-years. Market exclusivity practice is another major barrier because brand name monopolies may delay widespread access to SGLT2 inhibitors.…”

Section: Benefits and Risks In Different Populationsmentioning

confidence: 99%

SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

Tuttle

Brosius

Cavender

et al. 2021

American Journal of Kidney Diseases

View full text Add to dashboard Cite

Diabetes is the most frequent cause of chronic kidney disease (CKD), leading to nearly half of all cases of kidney failure requiring replacement therapy. The principal cause of death among patients with diabetes and CKD is cardiovascular disease (CVD). Sodium/glucose cotransporter 2 (SGLT2) inhibitors were developed to lower blood glucose levels by inhibiting glucose reabsorption in the proximal tubule. In clinical trials designed to demonstrate the CVD safety of SGLT2 inhibitors in type 2 diabetes mellitus (T2DM), consistent reductions in risks for secondary kidney disease end points (albuminuria and a composite of serum creatinine doubling or 40% estimated glomerular filtration rate decline, kidney failure, or death), along with reductions in CVD events, were observed. In patients with CKD, the kidney and CVD benefits of canagliflozin were established by the CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial in patients with T2DM, urinary albumin-creatinine ratio > 300 mg/g, and estimated glomerular filtration rate of 30 to <90 mL/min/1.73 m 2. To clarify and support the role of SGLT2 inhibitors for treatment of T2DM and CKD, the National Kidney Foundation convened a scientific workshop with an international panel of more than 80 experts. They discussed the current state of knowledge and unanswered questions to propose therapeutic approaches and delineate future research. SGLT2 inhibitors improve glomerular hemodynamic function and are thought to ameliorate other local and systemic mechanisms involved in the pathogenesis of CKD and CVD. SGLT2 inhibitors should be used when possible by people with T2DM to reduce risks for CKD and CVD in alignment with the clinical trial entry criteria. Important risks of SGLT2 inhibitors include euglycemic ketoacidosis, genital mycotic infections, and volume depletion. Careful consideration should be given to the balance of benefits and harms of SGLT2 inhibitors and risk mitigation strategies. Effective implementation strategies are needed to achieve widespread use of these life-saving medications. Complete author and article information provided before references.

show abstract

Section: Benefits and Risks In Different Populationsmentioning

confidence: 99%

SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

Tuttle

Brosius

Cavender

et al. 2021

American Journal of Kidney Diseases

View full text Add to dashboard Cite

show abstract

“…Even with greater awareness of the benefits of SGLT2 inhibitors, their high cost poses a barrier to use. Using a participant-level simulation model and U.K. health care costs, empagliflozin in addition to standard of care is projected to be cost-effective (101). The model predicted that although patients would incur increased out-of-pocket cost, empagliflozin in addition to standard of care would result in Table 5-Proposed research to increase uptake of SGLT2 inhibitors…”

Section: Optimizing Uptake Of Sglt2 Inhibitorsmentioning

confidence: 99%

SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

et al. 2020

View full text Add to dashboard Cite

Diabetes is the most frequent cause of chronic kidney disease (CKD), leading to nearly half of all cases of kidney failure requiring replacement therapy. The principal cause of death among patients with diabetes and CKD is cardiovascular disease (CVD). Sodium/glucose cotransporter 2 (SGLT2) inhibitors were developed to lower blood glucose levels by inhibiting glucose reabsorption in the proximal tubule. In clinical trials designed to demonstrate the CVD safety of SGLT2 inhibitors in type 2 diabetes mellitus (T2DM), consistent reductions in risks for secondary kidney disease end points (albuminuria and a composite of serum creatinine doubling or 40% estimated glomerular filtration rate decline, kidney failure, or death), along with reductions in CVD events, were observed. In patients with CKD, the kidney and CVD benefits of canagliflozin were established by the CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial in patients with T2DM, urinary albumin-creatinine ratio >300 mg/g, and estimated glomerular filtration rate of 30 to <90 mL/min/1.73 m2. To clarify and support the role of SGLT2 inhibitors for treatment of T2DM and CKD, the National Kidney Foundation convened a scientific workshop with an international panel of more than 80 experts. They discussed the current state of knowledge and unanswered questions in order to propose therapeutic approaches and delineate future research. SGLT2 inhibitors improve glomerular hemodynamic function and are thought to ameliorate other local and systemic mechanisms involved in the pathogenesis of CKD and CVD. SGLT2 inhibitors should be used when possible by people with T2DM to reduce risks for CKD and CVD in alignment with the clinical trial entry criteria. Important risks of SGLT2 inhibitors include euglycemic ketoacidosis, genital mycotic infections, and volume depletion. Careful consideration should be given to the balance of benefits and harms of SGLT2 inhibitors and risk mitigation strategies. Effective implementation strategies are needed to achieve widespread use of these life-saving medications.

show abstract

“…Several studies and conference abstracts reported the cost-effectiveness/utility of empagliflozin, across the perspective of payers in several countries, as monotherapy, dual or triple therapy, or in comparison to the standard of care in individuals with T2DM. [17][18][19][20][33][34][35][36][37][38] A majority of these studies analyzed data from EMPA-REG OUTCOME trial. The results consistently demonstrated that treatment with empagliflozin was found to be cost-effective compared to the BASC treatment in individuals with T2DM and cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…A Microsoft Excel-based patient-level simulation model has been used to assess the pharmacoeconomic profiles of empagliflozin in several other countries. [18][19][20] In this study, the model was adapted to the Chinese setting and applied to determine the cost-utility of empagliflozin versus placebo on top of BASC over a lifetime horizon, from the perspective of Chinese healthcare payer. A total of 5000 patients that randomly sampled from the EMPA-REG OUTCOME trial were simulated for base-case analysis.…”

Section: Model Structurementioning

confidence: 99%

“…Previous research articles have examined the pharmacoeconomic profiles of empagliflozin in the USA, UK, Greece and Japan, using Markov model or discrete event simulation model. [17][18][19][20] However, these results could not be transferred to other countries due to the significant differences of costs and health systems among countries. Currently, there was no model-based pharmacoeconomic analysis of empagliflozin in China, and also no published real-world study around the effectiveness and/or cost-effectiveness of empagliflozin.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

<p>Empagliflozin in Type 2 Diabetes Mellitus Patients with High Cardiovascular Risk: A Model-Based Cost-Utility Analysis in China</p>

Men¹,

Liu²,

Zhai³

2020

DMSO

View full text Add to dashboard Cite

Purpose: To evaluate the cost-utility of empagliflozin, in addition to best available standard care (BASC), for the treatment of adult patients with T2DM at high cardiovascular risk from the Chinese healthcare system perspective. Methods: A Microsoft Excel-based patient-level simulation model, based on the EMPA-REG OUTCOME trial data, was adapted and used to project individual's clinical and economic outcomes over a lifetime horizon. The cost and utility values were derived from databases and published studies. Numbers and rates of diabetes-related events, life-years (LYs), quality-adjusted life-years (QALYs), costs (¥ 2019) as well as incremental cost-utility ratios (ICURs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the model results. Results: Compared with BASC, empagliflozin plus BASC was predicted to result in an additional 1.01 QALYs (8.05 QALYs vs 7.04 QALYs) at an incremental cost of ¥4002 per patient. The modeled ICUR was ¥3988 per QALY gained, which was considered highly cost-effective in China compared to both one and three times the GDP per capita in 2019 (¥70,892 and ¥212,676). The deterministic and probabilistic sensitivity analyses confirmed the robustness of base-case results. Conclusion: This is the first cost-utility analysis regarding the use of empagliflozin in patients with T2DM in China, the world's most affected country by the T2DM pandemic. The economic evaluation suggests that empagliflozin added to BASC was estimated to be a highly value-for-money option for the treatment of adult patients with T2DM at high cardiovascular risk in the Chinese healthcare setting.

show abstract

Cost‐effectiveness analysis of empagliflozin treatment in people with Type 2 diabetes and established cardiovascular disease in the EMPA‐REG OUTCOME trial

Cited by 32 publications

References 18 publications

SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

<p>Empagliflozin in Type 2 Diabetes Mellitus Patients with High Cardiovascular Risk: A Model-Based Cost-Utility Analysis in China</p>

Contact Info

Product

Resources

About