Projecting the incidence and costs of major cardiovascular and kidney complications of type 2 diabetes with widespread SGLT2i and GLP-1 RA use: a cost-effectiveness analysis

Morton, Jedidiah I; Marquina, Clara; Shaw, Jonathan E.; Liew, Danny; Polkinghorne, Kevan R.; Ademi, Zanfina; Magliano, Dianna J.

doi:10.1007/s00125-022-05832-0

Cited by 17 publications

(5 citation statements)

References 44 publications

(56 reference statements)

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“…We acknowledge that newer noninsulin agents such as SGLT2i and GLP-1RA may carry long-term benefits from reducing risks of CV and renal events. In particular, SGLT2i were suggested to be cost-effective even at the current price ( 38 ), and would be prescribed more in the foreseeable future. However, when these newer agents are not accessible or are contraindicated, the concern for CV safety should not be a barrier to prescribing SU.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study

et al. 2023

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OBJECTIVE To assess the real-world cardiovascular (CV) safety for sulfonylureas (SU), in comparison with dipeptidylpeptidase-4 inhibitors (DPP4i) and thiazolidinediones (TZD), through development of robust methodology for causal inference in a whole nation study. RESEARCH DESIGN AND METHODS A cohort study was performed including people with type 2 diabetes diagnosed in Scotland before 31 December 2017, who failed to reach HbA1c 48 mmol/mol despite metformin monotherapy and initiated second-line pharmacotherapy (SU/DPP4i/TZD) on or after 1 January 2010. The primary outcome was composite major adverse cardiovascular events (MACE), including hospitalization for myocardial infarction, ischemic stroke, heart failure, and CV death. Secondary outcomes were each individual end point and all-cause death. Multivariable Cox proportional hazards regression and an instrumental variable (IV) approach were used to control confounding in a similar way to the randomization process in a randomized control trial. RESULTS Comparing SU to non-SU (DPP4i/TZD), the hazard ratio (HR) for MACE was 1.00 (95% CI: 0.91–1.09) from the multivariable Cox regression and 1.02 (0.91–1.13) and 1.03 (0.91–1.16) using two different IVs. For all-cause death, the HR from Cox regression and the two IV analyses was 1.03 (0.94–1.13), 1.04 (0.93–1.17), and 1.03 (0.90–1.17). CONCLUSIONS Our findings contribute to the understanding that second-line SU for glucose lowering are unlikely to increase CV risk or all-cause mortality. Given their potent efficacy, microvascular benefits, cost effectiveness, and widespread use, this study supports that SU should remain a part of the global diabetes treatment portfolio.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study

et al. 2023

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“…We acknowledge that newer noninsulin agents such as SGLT2i and GLP-1RA may carry long-term benefits from reducing risks of CV and renal events. In particular, SGLT2i were suggested to be costeffective even at the current price (38), and would be prescribed more in the foreseeable future. However, when these newer agents are not accessible or are contraindicated, the concern for CV safety should not be a barrier to prescribing SU.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular safety in type 2 diabetes with sulfonylureas as second-line drugs: a nation-wide population based comparative safety study

WANG¹,

Cordiner²,

Huang³

et al. 2023

Preprint

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<p> </p> <h2>Objective</h2> <p>To assess the real-world cardiovascular (CV) safety for SU, in comparison with dipeptidylpeptidase-4 inhibitors (DPP4i) and thiazolidinediones (TZD) through development of robust methodology for causal inference in a whole nation study. </p> <h2>Research Design and Methods</h2> <p>A cohort study was performed including people with type 2 diabetes diagnosed in Scotland before 31 December 2017, who failed to reach HbA1c 48 mmol/mol despite metformin monotherapy and initiated second-line pharmacotherapy (SU/DPP4i/TZD) on or after 1 January 2010.</p> <p>The primary outcome was the composite major adverse cardiovascular events (MACE), including hospitalization for myocardial infarction (MI), ischemic stroke, heart failure, and CV death. Secondary outcomes were each individual endpoint and all-cause death. Multivariable Cox proportional hazards regression and an instrumental variable (IV) approach were used to control confounding in a similar way to the randomization process in a randomized control trial. </p> <h2>Results</h2> <p>Comparing SU to non-SU (DPP4i/TZD), the hazard ratio (HR) for MACE was 1.00 (95% CI: 0.91 to 1.09) from the multivariable Cox regression and 1.02 (0.91 - 1.13) and 1.03 (0.91- 1.16) using two different IVs. For all-cause death, the HR from Cox regression and the two IV analyses was 1.03 (0.94 - 1.13), 1.04 (0.93 - 1.17), and 1.03 (0.90 - 1.17). </p> <h2>Conclusion</h2> <p>Our findings contribute to the understanding that second-line SU for glucose lowering are unlikely to increase CV risk or all-cause mortality. Given their potent efficacy, microvascular benefits, cost effectiveness and widespread use, this study supports that SU should remain a part of the global diabetes treatment portfolio.Article </p>

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“…The chronic utility for people after an MI was set at 0.79 (95% confidence interval 0.73, 0.85), which was derived from a systematic review of utility values for people with MI (likely a mix of both EQ-5D-5L and EQ-5D-3L) [ 26 ], and applied to the background age-specific and sex-specific utility for people without MI. A non-fatal MI also incurred an acute disutility of 0.03 (0.01 for three cycles) [ 27 ], as previously described [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Lipid-Lowering Strategies for Primary Prevention of Coronary Heart Disease in the UK: A Cost-Effectiveness Analysis

Morton,

Marquina,

Lloyd

et al. 2023

PharmacoEconomics

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Aim We aimed to assess the cost effectiveness of four different lipid-lowering strategies for primary prevention of coronary heart disease initiated at ages 30, 40, 50, and 60 years from the UK National Health Service perspective. Methods We developed a microsimulation model comparing the initiation of a lipid-lowering strategy to current standard of care (control). We included 458,692 participants of the UK Biobank study. The four lipid-lowering strategies were: (1) low/moderate-intensity statins; (2) high-intensity statins; (3) low/moderate-intensity statins and ezetimibe; and (4) inclisiran. The main outcome was the incremental cost-effectiveness ratio for each lipid-lowering strategy compared to the control, with 3.5% annual discounting using 2021 GBP (£); incremental cost-effectiveness ratios were compared to the UK willingness-to-pay threshold of £20,000–£30,000 per quality-adjusted life-year. Results The most effective intervention, low/moderate-intensity statins and ezetimibe, was projected to lead to a gain in quality-adjusted life-years of 0.067 per person initiated at 30 and 0.026 at age 60 years. Initiating therapy at 40 years of age was the most cost effective for all lipid-lowering strategies, with incremental cost-effectiveness ratios of £2553 (95% uncertainty interval: 1270, 3969), £4511 (3138, 6401), £11,107 (8655, 14,508), and £1,406,296 (1,121,775, 1,796,281) per quality-adjusted life-year gained for strategies 1–4, respectively. Incremental cost-effectiveness ratios were lower for male individuals (vs female individuals) and for people with higher (vs lower) low-density lipoprotein-cholesterol. For example, low/moderate-intensity statin use initiated from age 40 years had an incremental cost-effectiveness ratio of £5891 (3822, 9348), £2174 (772, 4216), and was dominant (i.e. cost saving; −2,760, 350) in female individuals with a low-density lipoprotein-cholesterol of ≥ 3.0, ≥ 4.0 and ≥ 5.0 mmol/L, respectively. Inclisiran was not cost effective in any sub-group at its current price. Conclusions Low-density lipoprotein-cholesterol lowering from early ages is a more cost-effective strategy than late intervention and cost effectiveness increased with the increasing lifetime risk of coronary heart disease. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-023-01306-2.

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Projecting the incidence and costs of major cardiovascular and kidney complications of type 2 diabetes with widespread SGLT2i and GLP-1 RA use: a cost-effectiveness analysis

Cited by 17 publications

References 44 publications

Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study

Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study

Cardiovascular safety in type 2 diabetes with sulfonylureas as second-line drugs: a nation-wide population based comparative safety study

Lipid-Lowering Strategies for Primary Prevention of Coronary Heart Disease in the UK: A Cost-Effectiveness Analysis

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