Cost‐effectiveness of empagliflozin in the UK in an EMPA‐REG OUTCOME subgroup with type 2 diabetes and heart failure

Abstract

Aims Heart failure (HF) and type 2 diabetes (T2D), common co-morbidities, translate into worse patient prognoses and higher direct costs than for either condition alone. Empagliflozin has been shown to markedly reduce cardiovascular (CV) deaths and HF hospitalizations (HHF) in HF patients with T2D. This study evaluated the lifetime cost-effectiveness of supplementing standard of care (SoC) with empagliflozin, relative to SoC alone, in HF patients with T2D from the UK payer perspective. Methods and results An existing discrete-event simulation model was adapted for the economic evaluation. Risk equations developed from time-dependent parametric survival analyses using patient-level HF subpopulation data from the EMPA-REG OUTCOME trial were employed to predict CV and renal events. Non-CV death, utility weights, and costs were drawn from UK sources. Quality-adjusted life years (QALYs) and costs were discounted at 3.5% per annum. Relative to SoC, empagliflozin with SoC yielded fewer first HHF, recurrent HHF, CV death, and non-fatal myocardial infarction but more non-fatal stroke events. Empagliflozin with SoC vs. SoC alone was associated with increased average life expectancy (10.80 vs. 9.59 LYs) and quality of life (6.27 vs. 5.62 QALYs), though at higher lifetime cost (£18 197 vs. £16 829) per person, resulting in an incremental cost-effectiveness ratio of £2093 per QALY. The probability of empagliflozin being cost-effective in the HF subpopulation at a £20 000 per QALY willingness-to-pay threshold was 91%. Conclusions This analysis suggests that adding empagliflozin to SoC in HF patients with T2D constitutes a cost-effective use of UK healthcare resources and may provide long-term health benefits to patients.

Cost‐effectiveness of second‐line empagliflozin versus liraglutide for type 2 diabetes in the United States

“…Results of this analysis build on the available evidence showing that empagliflozin has economic benefits in various settings compared with different antidiabetic agents, and in a broader T2D population and in patients with T2D and established CVD. 6 , 12 , 29 , 30 , 31 , 32 , 33 , 34 , 35 Notably, other economic evaluations have identified empagliflozin as a dominant strategy versus liraglutide for the treatment of patients with T2D. 36 , 37 Using the IQVIA Core Diabetes Model, empagliflozin has been compared with liraglutide, both in addition to background standard of care therapies, in patients with T2D with established CVD in the UK and Denmark based on data from the EMPA‐REG OUTCOME and LEADER CVOTs.…”

Cost-Effectiveness of Icosapent Ethyl, Evolocumab, Alirocumab, Ezetimibe, or Fenofibrate in Combination with Statins Compared to Statin Monotherapy

“…These costs are based on a retrospective cohort study of 24,093 patients over 6 years in the UK. Costs for acute events amounted to £7842 for non-fatal MI, £11,512 for non-fatal stroke, £3517 for unstable angina, and £7337 for coronary revascularisation [27,28]. Spending for the "Alive with CVD" state of £3466 per year was based on the treatment cost of patients with established CVD, e.g., after MI, stroke, angina pectoris, and associated comorbidities, e.g., arterial hypertension, diabetes mellitus, and chronic kidney diseases [27,28].…”

“…Costs for acute events amounted to £7842 for non-fatal MI, £11,512 for non-fatal stroke, £3517 for unstable angina, and £7337 for coronary revascularisation [27,28]. Spending for the "Alive with CVD" state of £3466 per year was based on the treatment cost of patients with established CVD, e.g., after MI, stroke, angina pectoris, and associated comorbidities, e.g., arterial hypertension, diabetes mellitus, and chronic kidney diseases [27,28]. Costs for non-CVD deaths were estimated at £2734 based on the NHS expense during the last 90 days of life weighted by the location of death [29,30].…”

Informing and Empowering Patients and Clinicians to Make Evidence-Supported Outcome-Based Decisions in Relation to SGLT2 Inhibitor Therapies: The Use of the Novel Years of Drug administration (YoDa) Concept

“…Complex economic modelling studies may help to show the advantage of a particular drug against a specific outcome [ 37 , 38 ]. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year is a commonly used parameter to calculate a cost estimate but this is based on the overall therapeutic efficacy of a particular drug [ 39 , 40 ]. As per the National Institute for Health and Care Excellence technology appraisal guidance in the UK, the ICERs associated with all three SGLT2i as monotherapy were deemed comparable [ 5 ].…”