Sodium-Glucose Cotransporter 2 Inhibitors for Prevention of Heart Failure Events in Patients with Type 2 Diabetes Mellitus: A Cost Per Outcome Analysis


Background and Objective

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have significant efficacy in reducing the risk of hospitalization for heart failure (hHF) or cardiovascular (CV) mortality in patients with type 2 diabetes mellitus (T2DM). However, there are differences in HF outcomes between the SGLT2i. Therefore, we compared the cost needed to achieve these outcomes between empagliflozin, canagliflozin, and dapagliflozin.


We calculated the cost needed to treat (CNT) in order to prevent one event of hHF or CV mortality, by multiplying the annualized number needed to treat (NNT) to prevent one event, by the annual cost of each therapy. Efficacy estimates were extracted from published randomized controlled trial (RCT) data. A sensitivity analysis was performed to mitigate differences between the RCT populations. Drug costs were extracted from the 2020 US National Average Drug Acquisition Cost listing.


We figured empagliflozin’s CNT to be $664,464 (95% CI $499,872–$1,097,280), $1,535,387 (95% CI $886,074–$3,210,501) for canagliflozin, and $2,693,145 (95% CI $1,639,563–$11,092,206) for dapagliflozin. The sensitivity analysis confirmed the cost advantage of empagliflozin.


Our findings suggest that empagliflozin prescribed for preventing CV death or hHF in T2DM patients seems to be cost saving compared to treatment with canagliflozin, and dapagliflozin.

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  • 06 June 2020

    The original version of this article unfortunately contained a mistake. The correct information is given below.


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Corresponding author

Correspondence to Ronen Arbel.

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No funding was received to conduct this study.

Conflict of interest

Author RA declares he has no conflict of interest. Author EA declares he has no conflict of interest. Author AH declares he has no conflict of interest. Author JA has received non-financial support from Janssen Pharmaceuticals, Speaker, and consulting honorarium from Pfizer and Novonordisk.


Author RA initiated the study and wrote the initial draft. Author EA researched and analyzed the data and drafted the results section. Author AH contributed to the methods and discussion and edited the manuscript. Author JA reviewed the data analysis and the final draft of the manuscript.

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Arbel, R., Aboalhasan, E., Hammerman, A. et al. Sodium-Glucose Cotransporter 2 Inhibitors for Prevention of Heart Failure Events in Patients with Type 2 Diabetes Mellitus: A Cost Per Outcome Analysis. Clin Drug Investig 40, 665–669 (2020).

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