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

Abstract

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.

Methods

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.

Results

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.

Conclusions

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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Change history

  • 06 June 2020

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

References

  1. 1.

    Kosiborod M, Cavender MA, Fu AZ, Wilding JP, Khunti K, Holl RW, et al. Lower risk of heart failure and death in patients initiated on sodium-glucose cotransporter-2 inhibitors versus other glucose-lowering drugs. Circulation. 2017;136:249–59.

    CAS  Article  Google Scholar 

  2. 2.

    Fitchett D, Inzucchi SE, Cannon CP, et al. Empagliflozin reduced mortality and hospitalization for heart failure across the spectrum of cardiovascular risk in the EMPA-REG OUTCOME trial. Circulation. 2019;139(11):1384–95.

    CAS  Article  Google Scholar 

  3. 3.

    Rådholm K, Figtree G, Perkovic V, Solomon SD, Mahaffey KW, de Zeeuw D, et al. Canagliflozin and heart failure in type 2 diabetes mellitus. Circulation. 2018;138(5):458–68.

    Article  Google Scholar 

  4. 4.

    Kato ET, Silverman MG, Mosenzon O, Zelniker TA, Cahn A, Furtado RHM, et al. Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus. Circulation. 2019;139(22):2528–36.

    CAS  Article  Google Scholar 

  5. 5.

    Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, et al. Type 2 diabetes mellitus and heart failure: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation. 2019;139:1–31.

    Article  Google Scholar 

  6. 6.

    American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S98–110. https://doi.org/10.2337/dc20-S009

    Article  Google Scholar 

  7. 7.

    Täger T, Atar D, Agewall S, Katus HA, Grundtvig M, Cleland JGF, et al. Comparative efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for cardiovascular outcomes in type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials. Heart Fail Rev. 2020. https://doi.org/10.1007/s10741-020-09954-8.

    Article  PubMed  Google Scholar 

  8. 8.

    Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–288.

    CAS  Article  Google Scholar 

  9. 9.

    Neal B, Perkovic V, Kenneth W, de Mahaffey ZD, Fulcher G, Erondu N, Shaw W, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.

    CAS  Article  Google Scholar 

  10. 10.

    Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–57.

    CAS  Article  Google Scholar 

  11. 11.

    Mayne TJ, Whalen E, Vu A. Annualized was found better than absolute risk reduction in the calculation of number needed to treat in chronic conditions. J Clin Epidemiol. 2006;59:217–23.

    Article  Google Scholar 

  12. 12.

    https://data.medicaid.gov/Drug-Pricing-and-Payment/NADAC-National-Average-Drug-Acquisition-Cost-/a4y5-998d/data.

  13. 13.

    Mendes D, Alves C, Batel-Marques F. Number needed to treat (NNT) in clinical literature: an appraisal. BMC Med. 2017;15(1):1–13.

    Article  Google Scholar 

  14. 14.

    Lehrke M, Marx N. Diabetes mellitus and heart failure. Am J Cardiol. 2017;120:S37–47.

    CAS  Article  Google Scholar 

  15. 15.

    Packer M. Heart failure: the most important, preventable, and treatable cardiovascular complication of type 2 diabetes. Diabetes Care. 2018;41:11–3.

    CAS  Article  Google Scholar 

  16. 16.

    Verma S, Jüni P, Mazer CD. Pump, pipes, and filter: do SGLT2 inhibitors cover it all? Lancet. 2019;393:3–5.

    Article  Google Scholar 

  17. 17.

    McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995–2008.

    CAS  Article  Google Scholar 

  18. 18.

    Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393:31–9.

    CAS  Article  Google Scholar 

  19. 19.

    Rahman W, Solinsky PJ, Munir KM, Lamos EM. Pharmacoeconomic evaluation of sodium-glucose transporter-2 (SGLT2) inhibitors for the treatment of type 2 diabetes. Expert Opin Pharmacother. 2019;20:151–61.

    CAS  Article  Google Scholar 

  20. 20.

    Kaku K, Haneda M, Sakamaki H, Yasui A, Murata T, Ustyugova A, et al. Cost-effectiveness analysis of empagliflozin in japan based on results from the Asian population in the EMPA-REG OUTCOME Trial. Clin Ther. 2019;41:2021–40.

    Article  Google Scholar 

  21. 21.

    Nguyen E, Coleman CI, Nair S, Weeda ER. Cost-utility of empagliflozin in patients with type 2 diabetes at high cardiovascular risk. J Diabetes Complicat. 2018;32:210–5.

    Article  Google Scholar 

  22. 22.

    Hou X, Wan X, Wu B. Cost-effectiveness of canagliflozin versus dapagliflozin added to metformin in patients with type 2 diabetes in China. Front Pharmacol. 2019;10:1–8.

    Article  Google Scholar 

  23. 23.

    Neslusan C, Teschemaker A, Willis M, Johansen P, Vo L. Cost-effectiveness analysis of canagliflozin 300 mg versus dapagliflozin 10 mg added to metformin in patients with type 2 diabetes in the United States. Diabetes Ther. 2018;9:565–81.

    CAS  Article  Google Scholar 

  24. 24.

    Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomized trials. BMJ. 2010;340:c869.

    Article  Google Scholar 

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Corresponding author

Correspondence to Ronen Arbel.

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Funding

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.

Authorship

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). https://doi.org/10.1007/s40261-020-00929-z

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