Endocrine Abstracts

Background

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce deaths and cardiovascular events in patients with type 2 diabetes mellitus (T2DM), but are currently not used as first-line therapy.

Objective

To evaluate the cost-effectiveness of introducing empagliflozin into the current standard care (metformin monotherapy) for patients with newly diagnosed T2DM and existing cardiovascular disease (CVD).

Methods

A lifetime horizon Markov decision analytic model was developed from the perspective of Qatari healthcare system to compare first-line empagliflozin combined with metformin vs metformin monotherapy for patients aged 50 to 79 + years with T2DM and existing CVD. Two health states were considered: ’alive’ and ’dead’. Patients entering the model transitioned to non-fatal myocardial infarction, non-fatal stroke, hospitalisation for heart failure, hospitalisation for unstable angina, death from cardiovascular or non-cardiovascular causes. Efficacy, healthcare costs, and health state utilities were ascertained from published sources as well as publicly available sources in Qatar. The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (QALY) and years of life saved (YoLS). Base-case multivariate uncertainty analysis was considered for this study. Costs and outcomes were discounted at 3% per annum. Sensitivity analyses were conducted to evaluate parameter uncertainty.

Results

Adding empagliflozin to current standard care led to additional 1.9 YoLS and 1.5 QALYs with an incremental cost of QAR 56, 869 (USD 15, 619), which equated to an incremental cost-effectiveness ratio of QAR 30, 675 (USD 8, 425) per YoLS and QAR 39, 245 (USD 10, 779) per QALY. Sensitivity analyses showed the findings to be robust.

Conclusions

First-line empagliflozin combined with metformin appears to be a cost-effective therapeutic option for patients with T2DM and CVD in Qatar.