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Cost-effectiveness of intensification with SGLT2 inhibitors for type 2 diabetes

Manjiri Pawaskar, S Pinar Bilir, Stacey Kowal

  • 1Merck & Co Inc, 126 E Lincoln Ave, Rahway, NJ 07065.

The American Journal of Managed Care
|August 30, 2021
PubMed
Abstract

Insights

Adding sodium-glucose cotransporter 2 (SGLT2) inhibitors to metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors is more cost-effective than switching to glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for type 2 diabetes patients. This strategy offers improved survival and significant cost savings.

Area of Science:

  • Endocrinology
  • Pharmacoeconomics
  • Diabetes Management

Background:

  • Type 2 diabetes (T2D) management often requires treatment intensification when dual therapy with metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors fails to achieve glycemic targets.
  • Patients with T2D not at glycated hemoglobin A1c (HbA1c) goal face increased risks of microvascular and macrovascular complications.

Purpose of the Study:

  • To compare the lifetime cost-effectiveness of two common treatment intensification strategies in T2D: adding a sodium-glucose cotransporter 2 (SGLT2) inhibitor versus switching to a glucagon-like peptide 1 receptor agonist (GLP-1 RA).
  • To evaluate these strategies from a US payer perspective.

Main Methods:

  • A cost-effectiveness analysis was conducted using the IQVIA Core Diabetes Model, a validated simulation tool.
  • Treatment effects were derived from randomized clinical trials and economic data from published literature.
  • Risk of adverse events and complications were simulated, with outcomes including life-years (LYs), quality-adjusted life-years (QALYs), and total costs.

Main Results:

  • Adding an SGLT2 inhibitor to existing metformin and DPP-4 inhibitor therapy dominated switching to a GLP-1 RA over a lifetime horizon.
  • The SGLT2 inhibitor strategy resulted in an improvement of 0.049 LYs and 0.026 QALYs, with associated cost savings of $9511.
  • Scenario analyses and probabilistic sensitivity analyses confirmed the base-case findings of improved efficacy and cost-effectiveness.

Conclusions:

  • Intensifying therapy with an SGLT2 inhibitor alongside a DPP-4 inhibitor is a more effective and cost-saving strategy compared to switching to a GLP-1 RA for T2D patients not at glycemic goal.
  • This finding supports the use of SGLT2 inhibitors as a preferred next step in treatment intensification for this patient population.

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