The cost‐effectiveness of dapagliflozin in treating high‐risk patients with type 2 diabetes mellitus: An economic evaluation using data from the DECLARE‐TIMI 58 trial

McEwan, Phil; Morgan, Angharad R.; Boyce, Rebecca; Bergenheim, Klas; Gause‐Nilsson, Ingrid; Bhatt, Deepak L.; Leiter, Lawrence A.; Johansson, Peter; Mosenzon, Ofri; Cahn, Avivit; Wilding, John

doi:10.1111/dom.14308

Cited by 23 publications

(23 citation statements)

References 57 publications

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“…Our findings are similar to those published in an economic evaluation of dapagliflozin performed in the UK, in which the Cardiff T2DM model was also adapted according to the survival results of the DECLARE-TIMI 58 trial [ 45 ]. In that study, dapagliflozin was a dominant alternative compared with placebo, resulting in 0.06 more QALYs and cost-savings of £ 2,552.…”

Section: Discussionsupporting

confidence: 88%

“…In that study, dapagliflozin was a dominant alternative compared with placebo, resulting in 0.06 more QALYs and cost-savings of £ 2,552. These results were maintained in the subgroup analysis, which evaluated patients with established cardiovascular disease, multiple risk factors, and prior HF, and highlighted the potential of dapagliflozin to reduce the economic burden of T2DM and its associated complications [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study

Escobar

Morales²,

Capel

et al. 2022

BMC Health Serv Res

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Background The objective of this study was to carry out a cost-effectiveness analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), for the treatment of type 2 diabetes mellitus (T2DM) in Spain, based on the results of the DECLARE-TIMI 58 trial. Methods A discrete event simulation model (Cardiff T2DM) based on the data observed in the DECLARE-TIMI 58 trial was adapted to the Spanish setting to estimate the costs and health outcomes of treatment with dapagliflozin in patients with T2DM who had or were at risk of atherosclerotic cardiovascular disease. Macrovascular events (hospitalization for heart failure, myocardial infarction, stroke, and unstable angina), end-stage renal disease and cardiovascular and non-cardiovascular mortality were modeled according to the survival equations of the DECLARE-TIMI 58 study. Microvascular events (blindness and ulcers) were estimated based on the risk equations of the UK Prospective Diabetes Study. The analysis was conducted from the Spanish National Health System perspective and the time horizon was 30 years. The results were evaluated in terms of cost per quality-adjusted life year (QALY) gained. Only direct health costs were included, and a 3% discount rate was applied to costs and health outcomes. Univariate and probabilistic sensitivity analyses (PSA) were made to assess the robustness of the results. Results In the main analysis, dapagliflozin was a dominant therapeutic option compared with placebo, with greater effectiveness (0.08 QALYs) and lower associated total costs per patient (€ -2,921). The univariate sensitivity analysis and the PSA confirmed the robustness of the results. The PSA showed the probability that dapagliflozin was a dominant alternative compared with placebo was 84.2% and that it was cost-effective of 92.1%, under a willingness-to-pay of € 20,000/QALY gained. Conclusions The analysis of data from the DECLARE-TIMI 58 trial shows that dapagliflozin would be a cost-effective option in Spain for the treatment of adult patients with T2DM, as an add-on therapy to SoC, compared with placebo.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study

Escobar

Morales²,

Capel

et al. 2022

BMC Health Serv Res

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show abstract

“…Typically, this would be undertaken within the context of a specific indication, eg, as a treatment for T2DM, HF, or CKD, using a CEA framework. Indeed, SGLT2is have been found to be cost-effective for the management of T2DM, 5,6 as well as for the management of patients with HF, with and without T2DM, 7 and in those with CKD, with and without T2DM. 8 However, as T2DM, CKD, and HF are closely linked in terms of pathophysiology and are integrally associated with one another within the context of health care system activity, CEA of the individual diseases may miss concomitant benefits on related diseases.…”

Section: What This Study Addsmentioning

confidence: 99%

Cardiorenal disease in the United States: Future health care burden and potential impact of novel therapies

McEwan

Morgan

Boyce

et al. 2022

JMCP

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BACKGROUND: Currently, concerted efforts to identify, prevent, and treat type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD) comorbidities are lacking at the institutional level, with emphasis placed on individual specialties. An integrated approach to tackle T2DM, HF, and CKD within the context of cardiorenal disease has the potential to improve outcomes and reduce costs at the system level. OBJECTIVE:To synthesize published evidence describing the burden of those diagnosed with T2DM, HF, and CKD in the United States as individual discrete chronic conditions, in order to evaluate the potential economic impact of novel therapies in this population. METHODS:We developed a compartmental Markov model with an annual time cycle to model an evolving prevalent US patient population with T2DM, HF, or CKD over the period 2021-2030 (either in isolation or combined). The model was used to explore the potential impact of novel therapies such as sodium-glucose cotransporter 2 inhibitors on future disease burden, by extrapolating the results of relevant clinical trials to representative patient populations. RESULTS:The model estimates that total prevalence across all disease states will have increased by 28% in 2030. Cumulatively, the direct health care cost of cardiorenal disease between 2021 and 2030 is estimated at $4.8 trillion. However, treatment with dapagliflozin has the potential to reduce disease prevalence by 8.0% and estimated cumulative service delivery costs by 3.6% by 2030. CONCLUSIONS:Considering a holistic approach when managing patients with cardiorenal disease offers an opportunity to reduce the disease burden over the next 10 years in the US population.

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“…In a study based out of the United Kingdom by McEwan et al, the treatment with dapagliflozin was noted to reduce the lifetime cost by £2552 in patients with type II DM for major adverse CV events. 30 Similar favorable cost-benefit ratios were seen in studies based on Australian and Thai healthcare systems. 31 , 32 In a study performed on data extrapolated to the American healthcare system, it was found that the addition of dapagliflozin to GDMT was beneficial in terms of long term cost-benefit ratios, possibly in both diabetic and non-diabetic populations.…”

Section: Existing Literature On Role Of Dapagliflozin In Cardiorenal Diseasementioning

confidence: 55%

The Role of Dapagliflozin in the Management of Heart Failure: An Update on the Emerging Evidence

Gupta¹,

Rao²,

Manek³

et al. 2021

TCRM

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The burden and cost of heart failure management, primarily in the form of hospitalization in the setting of decompensated heart failure, continue to be some of the biggest clinical challenges in cardiovascular medicine. In recently published randomized controlled trials, including DAPA-HF, sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin was shown to reduce hospitalization from heart failure or mortality associated with cardiovascular causes, when added to existing guideline-directed medical therapy. The American College of Cardiology (ACC) released a Clinical Pathway guideline that recommends the use of dapagliflozin in clinical management of heart failure, with or without diabetes. Furthermore, the results of the DAPA-CKD trial broaden the utility of dapagliflozin as a therapeutic option in patients with advanced kidney disease. In this article, the authors explore the existing evidence on dapagliflozin in heart failure with reduced ejection fraction and highlight the need for further research on uses of dapagliflozin in the world of heart failure.

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The cost‐effectiveness of dapagliflozin in treating high‐risk patients with type 2 diabetes mellitus: An economic evaluation using data from the DECLARE‐TIMI 58 trial

Cited by 23 publications

References 57 publications

Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study

Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study

Cardiorenal disease in the United States: Future health care burden and potential impact of novel therapies

The Role of Dapagliflozin in the Management of Heart Failure: An Update on the Emerging Evidence

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