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Cost-Utility and Budget Impact Analysis of Adding SGLT-2 Inhibitors to Standard Treatment in Type 2 Diabetes Patients
Tanawan Kongmalai1,2,3, Juthamas Prawjaeng2, Phorntida Hadnorntun2
1Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.
Insights
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve quality-adjusted life-years (QALYs) for type 2 diabetes patients with heart failure (T2D-HF). However, SGLT2i are not cost-effective in Thailand at current prices.
Area of Science:
- Pharmacoeconomics
- Cardiovascular Medicine
- Endocrinology
Background:
- Heart failure (HF) in type 2 diabetes (T2D) presents a significant burden.
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) offer cardiovascular benefits but are not on Thailand's essential medicines list.
- The cost-effectiveness of SGLT2i for T2D-HF patients in Thailand is unassessed.
Purpose of the Study:
- To evaluate the cost-utility of incorporating SGLT2i into standard T2D-HF treatment in Thailand.
- To determine the economic value of SGLT2i from a societal perspective.
Main Methods:
- A lifetime horizon Markov model with 3-month cycles was utilized.
- Efficacy data sourced from systematic reviews and meta-analyses.
- Cost and utility data were collected from Thai national databases and patient interviews.
Main Results:
- SGLT2i increased Quality-Adjusted Life-Years (QALYs) by 0.41 years on average.
- The Incremental Cost-Effectiveness Ratio (ICER) for overall SGLT2i was US$8480 per QALY gained, exceeding Thailand's willingness-to-pay threshold.
- Significant price reductions are needed for SGLT2i to become cost-effective.
Conclusions:
- SGLT2i reduce HF hospitalizations and mortality while improving QALYs in T2D-HF patients.
- At current prices, SGLT2i are not cost-effective for T2D-HF patients in Thailand.
- Cost reductions are necessary for SGLT2i to be considered a cost-effective treatment option.
Background:
Heart failure (HF) in type 2 diabetes (T2D) patients poses a significant clinical and financial burden. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown cardiovascular benefits in trials, they are not included in Thailand's National List of Essential Medicines (NLEM), and their value-for-money remains unassessed.
Objective:
This study aims to evaluate the cost-utility of adding SGLT2i to the standard treatment for T2D-HF patients in Thailand.
Methods:
A Markov model with 3-month cycles and a lifetime horizon was conducted from a societal perspective. Efficacy data came from a systematic review and meta-analysis. Transition probabilities and direct medical costs were derived from the National Health Security Office database, while direct non-medical costs and utility were collected through patient interviews at Siriraj hospital to reflect Thailand's context. The main outcomes were incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). A sensitivity and budget impact analysis were also performed.
Results:
Canagliflozin led to the highest increase in QALYs, at 1.21 years, followed by dapagliflozin (0.54 years) and empagliflozin (0.06 years). Collectively, SGLT2i yielded an increase of 0.41 QALYs. Canagliflozin incurred the highest additional treatment cost at United States dollars (US$)5600, followed by dapagliflozin (US$3547) and empagliflozin (US$2694). The ICERs for canagliflozin, dapagliflozin, empagliflozin, and overall SGLT2i were US$4632, US$6430, US$48,952, and US$8480 per QALY gained, respectively. SGLT2i were not cost-effective compared with Thailand's willingness-to-pay threshold of US$4564 per QALY gained. However, threshold analysis indicates that the costs of canagliflozin, dapagliflozin, empagliflozin, and overall SGLT-2i should be reduced by 2.3%, 38.2%, 90.2%, and 55.6%, respectively, to be cost-effective. Budget impact analysis revealed that the total budget for treating T2D patients with HF over 5 years is US$15.6 million.
Conclusions:
Adding SGLT2i to standard treatment reduced HF hospitalization and mortality rates and improved QALYs in T2D-HF patients. Nevertheless, they would not be cost-effective at current prices in Thailand.
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