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The results indicate that dipeptidyl peptidase-4 (DDP-4) inhibitors, which are widely prescribed in Germany, are not a cost-effective alternative despite their lower drug costs compared to empagliflozin.
Cardiovascular diseases (CVDs) account for the largest share of health care costs Type 2 diabetes (T2D) treatment, mostly due to hospital and surgical costs. However, overall costs and healthcare resource utilization (HCRU) associated with different T2D drug regimens have not been thoroughly investigated.
A Research It was published in the magazine ClinicoEconomics and Outcomes Research Comparison of sodium-glucose cotransporter type 2 (SGLT-2) inhibitor empagliflozin, glucagon-like peptide-1 receptor agonists (GLP-1-RA) and dipeptidyl peptidase-4 inhibitors (DPP-4) in patients with T2D in HCRU in Germany.
In addition to being antihyperglycemic, SGLT-2 agents have been shown to be beneficial for body weight, blood pressure, blood uric acid levels, and inflammation. They also reduce the risk of major cardiovascular events, cardiovascular disease and heart failure. GLP-1-RA drugs have shown positive cardiovascular outcomes and are recommended for patients with T2D who have not responded to initial therapy and who have pre-existing clinically significant CVD. DPP-4 agents are recommended for patients who do not initially respond to treatment and do not have a significant effect on the risk of heart failure.
It included 24,465 patients who started treatment with empagliflozin, DPP-4 or GLP-1-RA from 2015 to 2018 based on a nationwide claim in Germany. or 1 patient diagnosed with T2D. Treatment costs between propensity score-matched groups from baseline to end of data availability, therapy discontinuation, or death were compared in the analysis.
Of the total group, 3285 patients received empagliflozin, 19,443 DPP-4, and 1747 GLP-1-RA. Most patients in the DPP-4 group received sitagliptin (94.6%), although saxagliptin and vildagliptin were also prescribed in 5.4% and 0.1% of patients, respectively. Dulaglutide and liraglutide were the most common GLP-1-RAs, with 60.3% and 35% of these patients, respectively, and 4.7% receiving exenatide.
A total of 31.2% of patients started on empagliflozin had previous exposure to insulin therapy, as well as 15.7% of the DPP-4 group and 54.3% of the GLP-1-RA group. The most commonly used antidiabetic drug at baseline in all 3 groups was metformin. Patients treated with empagliflozin are more likely to take cardiovascular medications.
After matching across each regimen group based on sensitivity scores and adjusting for differences in length of follow-up, patients starting DPP-4 experienced higher mean costs than those on empagliflozin (€7009). [$7093.84] with 4274 euros [$4325.74]). The GLP-1-RA group had a higher cost than empagliflozin (€6851). [$6933.93] Compared to 4895 euros [$4954.25]).
Patient care accounted for the largest difference between empagliflozin and DPP-4 kit costs, followed by pharmacy sales of prescription drugs. For patients given GLP-1-RA, price differences are largely due to drug costs and the more potent dose of GLP-1-RA. These results were observed in patients receiving monotherapy, insulin-naïve patients, patients prescribed agents of interest in addition to insulin, and those receiving dual therapy with metformin.
While empagliflozin patients had fewer hospitalizations compared to the other treatment groups, in-hospital costs were higher and overall patient costs were similar between the empagliflozin group and the GLP-1-RA group. Among the 10 main reasons for hospitalization, 8 are related to CVD, which emphasizes the importance of reducing cardiovascular risk in T2D patients.
The data show different health care costs among T2D patients receiving empagliflozin, DPP-41i, and GLP-1-RA—particularly between patients on empagliflozin and DPP-4, particularly because of higher rates of CVD-related hospitalizations in the empagliflozin group.
“The results of this study indicate that DDP-4i treatment, which is widely prescribed in Germany, is not a cost-effective option, despite lower drug costs. [empagliflozin] Impa therefore requires healthcare providers to reconsider their current treatment regimens,” the authors concluded.
Further research is warranted to confirm the study results and to better understand the effectiveness of SLGT-2 inhibition for heart failure in real-world settings.
Ref
Wilke T, Picker N, Müller S, et al. Healthcare resource utilization and related costs in new users of empagliflozin versus DPP-4 inhibitors and GLP-1 agonists: a comparative analysis based on real-world data from the German Pain Fund. Clinicoecon Outcomes Res. Published online on May 2, 2022. doi:10.2147/CEOR.S357540
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