Implementation of Empagliflozin in Patients with Diabetes Mellitus Type 2 and Established Cardiovascular Disease: Estimation of 5-Year Survival and Costs in Sweden

Abstract

Introduction: Cardiovascular disease (CVD) affects approximately 30% of patients with diabetes mellitus type 2 (T2D) and leads to increased morbidity, decreased survival and increased healthcare utilization. The aim of this study was to estimate the impact of treating these patients with the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on survival and healthcare utilization. Methods: Actual survival and healthcare utilization data from a 5-year retrospective cohort

Empagliflozin reduces cardiorenal events, healthcare resource use and mortality in Sweden compared to dipeptidyl peptidase‐4 inhibitors: Real world evidence from the NordicEMPRISEstudy

“… 9 The beneficial effects of SGLT‐2 inhibitors on CV events and mortality, as well as on renal events, have been observed in clinical trials and observational studies, suggesting that SGLT‐2 inhibitors have the potential to provide additional benefits (other than glucose‐lowering) and to decrease HCRU in T2DM. 20 , 22 , 23 Empagliflozin is recommended in both international and national guidelines for treatment of patients with T2DM and established CVD as well as for T2DM and congestive heart failure. 24 , 25 Given the high economic burden of this disease in Sweden, we assessed the cardiorenal effectiveness and HCRU of empagliflozin use in comparison to DPP‐4i.…”

“…For T2DM patients with manifest CVD, empagliflozin is part of the Swedish standard of care 13 . The beneficial effects of empagliflozin on CV events and mortality, as well as on renal events, have been observed in both clinical trials and observational studies, suggesting the potential of empagliflozin to reduce HCRU 16‐20 . In the EMPA‐REG OUTCOME trial, empagliflozin reduced the risk of ACM, hospitalization for heart failure (HHF) and CV mortality (CVM) by 32%, 35% and 38% respectively compared with placebo 19 .…”

“…13 The beneficial effects of empagliflozin on CV events and mortality, as well as on renal events, have been observed in both clinical trials and observational studies, suggesting the potential of empagliflozin to reduce HCRU. 16 , 17 , 18 , 19 , 20 In the EMPA‐REG OUTCOME trial, empagliflozin reduced the risk of ACM, hospitalization for heart failure (HHF) and CV mortality (CVM) by 32%, 35% and 38% respectively compared with placebo. 19 However, there is limited evidence regarding CV and renal events and mortality associated with empagliflozin use in Sweden and its impact on HCRU.…”

Model‐based predictions on health benefits and budget impact of implementing empagliflozin in people with type 2 diabetes and established cardiovascular disease

“…Support for implementation of empagliflozin was also found in a Swedish 5‐year budget impact study based on register data of 5500 people with T2D and eCVD, which estimated a cost per quality‐adjusted life year (QALY) of 8100 euros (EUR) 29 . However, studies estimating the impact of alternate levels of implementation of SGLT‐2 inhibitors in line with treatment recommendations using model simulations have not yet been conducted in a Swedish context.…”

“…28 Support for implementation of empagliflozin was also found in a Swedish 5-year budget impact study based on register data of 5500 people with T2D and eCVD, which estimated a cost per quality-adjusted life year (QALY) of 8100 euros (EUR). 29 However, studies estimating the impact of alternate levels of implementation of SGLT-2 inhibitors in line with treatment recommendations using model simulations have not yet been conducted in a Swedish context. As T2D is a complex disease, models accounting for interrelationships between disease progression and multiple coexisting complications, as well as differences in background and clinical characteristics of patients, are needed for accurate predictions.…”