Utilization and Costs of Patients With Type-2 Diabetes and Cardiovascular Disease Treated With Sodium Glucose Cotransporter-2 Inhibitors and Glucagon Like Peptide-1 Receptor Agonists

OBJECTIVES: Our study aims to evaluate and compare the annual healthcare utilization and costs among individuals with T2D and CVD treated with either Sodium Glucose Cotransporter-2 inhibitors (SGLT-2i) or Glucagon Like Peptide-1 Receptor Agonists (GLP-1 RA) as some medications from these classes have shown reduced cardiovascular risk in type-2 diabetes (T2D) patients with or at risk of cardiovascular disease (CVD).

METHODS: A retrospective observational cohort study was conducted using commercial claims data from 2015-2022. Index date and index medication were defined based on the first prescription initiated in the identification period (1st April 2016 to 31st December 2021) from either SGLT-2i or GLP-1 RA class. The cohort included patients with T2D, and CVD, aged 18 years and above, who were continuously enrolled in medical and pharmacy benefits 6 months before and 12 months after the index date. Patients were labeled as SGLT-2i or GLP-1 RA users based on index medication. Inverse Probability Treatment Weighting (IPTW) was used to balance baseline covariates. Patient outcomes were evaluated over a 12-month period post-index date. Healthcare utilization and costs were assessed using negative binomial regression and a generalized linear model in the inpatient, outpatient, emergency, and pharmacy settings.

RESULTS: IPTW successfully balanced baseline covariates. Pharmacy costs for SGLT-2i were significantly lower than GLP-1 RA (-0.32, CI: -0.37, -0.26, p<0.0001). All-cause healthcare costs were also significantly lower in SGLT-2i users than GLP-1 RA users (-0.23, CI: -0.28, -0.18, p<0.0001) in the follow-up period. No significant difference was observed with respect to all-cause healthcare utilization in the two groups.

CONCLUSIONS: All-cause healthcare costs were significantly lower for SGLT-2i users versus GLP-1 RA users among T2D patients with CVD. These findings can be used to educate patients to inform shared decision-making and help payers make decisions related to formulary coverage alongside clinical evidence.