Health Economic Evaluation of Canagliflozin in the Treatment of Type 2 Diabetes Mellitus in France

Abstract

Objectives: Two SGLT-2 inhibitors, CANA and DAPA, are recommended in the UK for combination therapy in T2DM. Through an insulin-independent mechanism of action, SGLT-2 inhibitors improve glucose levels, blood pressure, and weight with a low inherent risk of hypoglycaemia. The cost-effectiveness of using CANA or DAPA in combination with MET was evaluated in patients inadequately controlled with MET monotherapy, from the perspective of the UK NHS. MethOds: The ECHO-T2DM model was used to estimate 40-year outcomes and costs associated with using CANA (100mg or 300mg) versus DAPA 10mg in dual therapy. HbA1c efficacy estimates were obtained from a Network Meta-Analysis (NMA). Analyses of pooled data from trials investigating CANA dual therapy (with MET) were used for parameters unavailable in the NMA (i. e., SBP, LDL, HDL and AEs). A broad set of sensitivity analyses were performed. Results: Both doses of CANA were associated with more QALYs (0.01,0. 03 for 100mg and 300mg, respectively) and higher costs (£101, £594, respectively). The associated incremental cost-effectiveness ratios (ICERs) were £7,423 and £17,734, respectively; both below the willingness-to-pay for QALY threshold in the UK. The key driver of the result for CANA 300mg was the greater HbA1c efficacy versus DAPA 10mg, and for CANA 100mg, a lower need for insulin rescue since CANA (but not DAPA) can be used in persons with moderate renal impairment. The ICERs were robust under all scenarios tested. Only use of UK-specific and not clinical trial patient characteristics substantively impacted the results; none reversed the interpretation of CANA as cost-effective versus DAPA. cOnclusiOns: SGLT-2 inhibitors reduce HbA1C, body weight, and blood pressure, and thus the risk of micro-and macrovascular complications. Economic simulations suggest that both doses of CANA are cost-effective versus DAPA in dual therapy treatment of T2DM (with MET) in the UK.

Canagliflozin in the treatment of type 2 diabetes: an evidence-based review of its place in therapy

“…This was also the case for canagliflozin 100 mg, based on economic evaluations in Spain56 and Poland,57 whereas canagliflozin 300 mg produced an ICER of €181356 and 45,008 zł57 compared with sitagliptin, respectively. Results from additional country-specific analyses versus sitagliptin also suggest that canagliflozin is likely to be a cost-effective option adjunct to metformin, in Ireland,58 France,59 Belgium,60 Slovakia,61 and the Czech Republic 62. Moreover, a NICE HTA for canagliflozin concluded that, due to small differences in costs and QALYs between canagliflozin and DPP-4 inhibitors, both canagliflozin 100 and 300 mg were recommended treatment options in patients inadequately controlled with metformin alone 63…”

“…In particular, from the Canadian health care perspective, canagliflozin 100 and 300 mg provided QALY gains of 0.28 and 0.31, and cost savings of C$2560 and C$2217, respectively, over a time horizon of 40 years. 68 Canagliflozin also dominated sitagliptin across different countries, including Belgium, 60 France, 59 Norway, 54 and Portugal, 55 when both dosing schemes were assessed as a single intervention. Of note, additional economic evaluations concluded that canagliflozin was a cost-effective therapeutic option as add-on to metformin and sulfonylurea in Brazil, 69 Ireland, 58 Slovakia, 61 and the Czech Republic, 62 although it was associated with higher treatment costs compared with sitagliptin.…”