Presentation (CTI)

OBJECTIVES: This study aimed to compare real-world healthcare resource utilization (HCRU) and costs among Medicare beneficiaries with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) who initiated once-weekly glucagon-like peptide-1 receptor agonists (OW GLP-1RAs) versus other non-insulin glucose-lowering therapies (NIGLTs).
METHODS: This observational cohort study used propensity score matching of Medicare Fee-For-Service claims data (2006-2022) to compare ASCVD-related and all-cause HCRU and medical costs in those with T2D and ASCVD who initiated OW GLP-1RAs versus other NIGLTs (except metformin). HCRU (inpatient [IP], outpatient [OP], and emergency department [ED] visits) and corresponding costs were assessed using negative binomial and quasi-Poisson models, respectively. Individual OW GLP-1RAs dulaglutide, semaglutide, and extended-release exenatide were also compared against sodium-glucose cotransporter-2 inhibitors (SGLT2is) and dipeptidyl peptidase-4 inhibitors (DPP-4is).
RESULTS: The OW GLP-1RA (n=77,712) and other NIGLT (n=174,260) cohorts were 40% female with a mean age of ~74 years. OW GLP-1 RAs were associated with 25% and 23% lower all-cause and ASCVD-related IP visits, respectively, as well as 12% and 11% lower all-cause and ASCVD-related ED visits, respectively, compared with other NIGLTs. All-cause and ASCVD-related IP and ED costs were also significantly lower among OW GLP-1RA users. Semaglutide users had significantly lower all-cause and ASCVD-related IP, OP, ED visits and costs compared with DPP-4i users. Compared with SGLT2is, semaglutide was associated with significantly lower all-cause and ASCVD-related IP visits as well as significantly lower ASCVD-related total (IP + OP + ED) visits and costs. Semaglutide users had significantly fewer coronary revascularizations compared to DPP-4i or SGLT2i users.
CONCLUSIONS: Expensive, avoidable HCRU and costs such as IP and ED visits, as well as revascularizations, were significantly lower among those initiating OW GLP-1RAs versus other NIGLTs. These findings suggest the cardiovascular benefits associated with OW GLP-1RAs may reduce the clinical and economic burden of comorbid T2D and ASCVD.