Can We Afford to Overlook the Cost of Avoidable Complications in Type 2 Diabetes: A Health Economic Analysis to Evaluate What Is the ‘Cost of Not’ Acting in Turkey?

OBJECTIVES: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce cardiovascular (CV) and renal complications and prolong survival in patients with type 2 diabetes (T2D). The objective of this study is to quantify the economic value of short and long-term reductions in CV and renal complications associated with the use of SGLT2i in T2D against other glucose-lowering drugs (oGLD) or placebo.

METHODS: A cohort-level partitioned survival model was developed to quantify economic (from payer perspective) and clinical outcomes associated with the results of clinical (CANVAS, EMPA-REG and DECLARE-TIMI 58) and real-world (CVD-REAL 1&2 pooled) studies comparing SGLT2i with placebo or oGLD, respectively. The model was applied over a time horizon of 20 years with 257,016 TRY willingness-to-pay threshold per incremental QALY. Data on healthcare resource utilisation, treatment costs and mortality were obtained for Turkey. The summarising outcome of the analysis was net monetary benefit (NMB) per person.

RESULTS:

0.5021 QALY gain (CVD-REAL study) and 0.2957 QALY gain (CV outcome trials (CVOTs)) was estimated per patient based on the reduction of CV and renal incidents. Based on CVOTs and CVD-REAL, fewer hospitalisations for heart failure, new end-stage-renal disease, stroke and myocardial infarction cases were estimated on SGLT2i compared to placebo or oGLD. A positive NMB/person for SGLT2i versus placebo or oGLD was observed, resulted from increased QALYs and reductions in all-cause mortality in patients receiving SGLT2i. Estimated 20-year NMB/person was 60,473 TRY vs placebo based on CVOTs and was 111,166 TRY vs oGLD based on CVD-REAL.

CONCLUSIONS:

The health economic modelling analysis has suggested a clear additional value to patients and payers, of reducing CV events by comparing the benefits of SGLT2 inhibitors against oGLD or placebo. Early introduction of SGLT2i in patients with T2D is a cost-effective therapeutic option with the potential to reduce the complications of T2D and increase quality of life.