Economic implications with newer agents to reduce cardiovascular risk in diabetes

Cardiovascular disease (CVD) plays a significant role in the morbidity and mortality in type 2 diabetes (T2D). In addition to the negative impact on the health of patients, people with T2D and CVD encounter higher total healthcare costs compared with patients with T2D and without CVD. The FDA guidance of 2008 recommending cardiovascular outcomes trials (CVOTs) for T2D drug candidates prompted pharmaceutical companies to conduct such studies. Some of those drug candidates appear to have beneficial physiologic effects on cardiovascular outcomes. Pharmacoeconomic analysis can correlate observed improvements to cardiovascular outcomes to savings in healthcare spending and assist health plans in assessing the value of diabetes medications. To date, most pharmacoeconomic studies for antihyperglycemic drugs have been conducted using surrogate markers of CVD risk (eg, glycated hemoglobin, systolic blood pressure, body mass index, plasma lipid levels) and have established the economic benefit and value of diabetes drugs based on reduction in cardiovascular events. A few analyses have been conducted based on CVOT efficacy data and similarly demonstrate value in patients at high CVD risk. Combined, the pharmacoeconomic data reinforce that newer agents with CVOT benefit represent good value in general, as well as for patients with high CVD risk, and support managed care decisions regarding treatment coverage and recommendations for newer diabetes agents.