Endocrine Abstracts

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are potentially an attractive option for initial combination therapy with metformin for type 2 diabetes mellitus (T2DM), which may help patients to achieve adequate glycaemic control and reduce cardiovascular disease (CVD). Empagliflozin has been shown to be superior compared to other SGLT2 inhibitors in reducing all-cause and cardiovascular mortality in patients with T2DM.

Aims

To evaluate the cost-effectiveness of first-line empagliflozin added to metformin vs metformin alone in patients with newly diagnosed T2DM and established CVD in Australia.

Methods

A Markov model was constructed to simulate cardiovascular events occurring in Australians currently aged 50 to 84 years with newly diagnosed T2DM and existing CVD. The cycle length was one year, and the base-case time horizon was five years. The model consisted of two health states: ’Alive’ and ’Dead’. Clinical inputs were based on data from Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose. Costs and utilities were extracted from published sources. The analyses were performed from an Australian public healthcare system perspective and from a societal perspective, with the latter ascribing the Australian Government’s ’value of statistical life year’ (VoSLY, AUD 213, 000) to each year lived by a person. The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (QALY) and years of life saved (YoLS). Future outcomes were discounted at a rate of 5% per anum. Sensitivity analyses were undertaken confirm robustness of the results.

Results

First-line use of empagliflozin in addition to metformin reduced overall cardiovascular events by 0.82% and death by 7.72% over five years, compared to metformin alone. There were 0.2 YoLS per person and 0.16 QALYs gained, at a net healthcare cost of AUD 4, 408. These equated to incremental cost-effectiveness ratios of AUD 22, 076 per YoLS and AUD 28, 244 per QALY gained. The gains in VoSLY equated to AUD 42, 530 per person, meaning that from a societal perspective, the intervention was cost saving.

Conclusion

First-line use of empagliflozin added to metformin appears to be a cost-effective strategy for the management of Australians with newly diagnosed T2DM and CVD.