Dapagliflozin for Prevention of Macrovascular Complication Among Diabetic Patients: A Cost-Utility Analysis

OBJECTIVES: The economic burden of type 2 diabetes mellitus (T2DM) becomes serious concern in the Indonesian National Health Insurance system. The effectiveness and efficiency of T2DM treatment should be improved in order to improve patient quality of life and reduce complications. Dapagliflozin is a new therapy for T2DM which is useful in reducing macrovascular complications. This study aims to determine the cost-effectiveness and -utility of dapagliflozin for particularly preventing macrovascular complications compared with standard therapy.

METHODS: The research uses a Markov model with a 1-year cycle over a 40-year time horizon, starting from age 30. The efficacy of dapagliflozin on preventing macrovascular complications was obtained from the DECLARE-TIMI trial. The incremental cost-effectiveness ratio (ICER) value is compared with the willingness to pay (WTP) of 1-3x gross domestic product per capita. Parameters influencing the ICER value were analyzed using one-way and probabilistic sensitivity tests.

RESULTS: The estimated total cost and QALYs of current treatment are IDR 64,563,608,920.00 and 18,200, respectively. While in the dapagliflozin cohort, the cost and the QALYs are IDR. 81,433,061,692.00 and 18,310, respectively. Furthermore, the ICER of Dapagliflozin is IDR. 154,215,757.00/QALYs and it is considerably cost-effective. The sensitivity analysis demonstrates that the probability of dapagliflozin to be cost-effectiveness is 37.8%.

CONCLUSIONS: Dapagliflozin was deemed to be cost-effective compared to standard therapy T2DM for preventing macrovascular complications.