Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses

Area of Science:

• Pharmacoeconomics
• Endocrinology
• Nephrology

Background:

• Heterogeneous treatment effects of SGLT2is are known, but their economic value in diverse real-world T2D populations is unclear.
• Subgroup cost-effectiveness analyses are crucial for understanding SGLT2i value across different patient profiles.

Purpose of the Study:

• To evaluate the cost-effectiveness of SGLT2is versus DPP4is in real-world T2D patients with varying clinical characteristics.
• To identify patient subgroups where SGLT2is offer the greatest economic value.

Main Methods:

• A multi-state transition model was employed to estimate ICERs and VBP over 5-year and lifetime horizons.
• Analyses stratified T2D patients by age, eGFR, HbA1c, and BMI, using Taiwanese data for treatment effects, utilities, and costs.
• Discount rates of 3% and 2022 cost standardization were applied, with sensitivity analyses performed.

Main Results:

• Over 5 years, ICERs varied by subgroup, with lower costs per QALY gained for older patients (≥65 years) and those with higher eGFR (60-90 ml/min/1.73 m²).
• Lifetime analyses showed consistently lower ICERs, particularly for the elderly (≥65 years).
• Value-based pricing indicated significant economic value for SGLT2is, especially in older T2D patients.

Conclusions:

• SGLT2is demonstrate high cost-effectiveness compared to DPP4is across various T2D patient subgroups.
• The elderly and patients with mild renal impairment represent key populations where SGLT2i adoption offers substantial economic benefits.