REAL-WORLD COMPARATIVE OUTCOMES AND COSTS OF SGLT-2 INHIBITORS VERSUS DPP-4 INHIBITORS IN TYPE 2 DIABETES PATIENTS WITH HEART FAILURE
Author(s)
Vikash Kumar Verma, MBA, PharmD1, Louis Brooks Jr, MS2, Marissa Seligman, PharmD3, Abhimanyu Roy, MBA4, Abhinav Nayyar, MBA, MBBS5, Ankitkumar Arora, MPharm6, Anuj Gupta, MSc7, Shikha Anand, Other8, Vishan Khatavkar, MBA8, Ankita Bhagat, MS9, Prateek Kumar, Other10, Manish Rawat, Other8, Archana Arya, MBA11, Vaibhav Bansal, Other8, Ankita Misra, MPH, MS6.
1Optum Lifesciences, Boston, MA, USA, 2Optum, Bloomsbury, NJ, USA, 3Optum Lifesciences, Winchester, MA, USA, 4Optum, Gurgaon, India, 5Optum Life Sciences, Gurugram, India, 6Optum Global Solutions, Gurgaon, India, 7Optum Lifesciences, Noida, India, 8Optum Lifesciences, Gurugram, India, 9Optum Lifesciences, Guragon, India, 10Optum Global Solutions, Hyderabad, India, 11Optum Global Solutions, Haryana, India.
1Optum Lifesciences, Boston, MA, USA, 2Optum, Bloomsbury, NJ, USA, 3Optum Lifesciences, Winchester, MA, USA, 4Optum, Gurgaon, India, 5Optum Life Sciences, Gurugram, India, 6Optum Global Solutions, Gurgaon, India, 7Optum Lifesciences, Noida, India, 8Optum Lifesciences, Gurugram, India, 9Optum Lifesciences, Guragon, India, 10Optum Global Solutions, Hyderabad, India, 11Optum Global Solutions, Haryana, India.
OBJECTIVES: Heart failure (HF) in patients with type 2 diabetes mellitus (T2DM) substantially increases morbidity, mortality, and healthcare costs. This study compared real-world clinical outcomes, healthcare resource utilization (HCRU), and costs among T2DM patients with newly diagnosed HF initiating SGLT-2 inhibitors (SGLT-2i) versus dipeptidyl peptidase-4 inhibitors (DPP-4i).
METHODS: A retrospective cohort study was conducted using Optum® Market Clarity claims and EHR data (Jan 2017-Jun 2025). Adults (≥18 years) with T2DM and a new HF diagnosis (ICD-10 codes) were included. Exclusions were type 1 or gestational diabetes, concurrent use of both drug classes, or prior use during the pre-index period. The index date was the first prescription refill for SGLT-2i or DPP-4i. Patients required ≥12 weeks of therapy or ≥3 refills (PDC ≥80%) and continuous eligibility for 12 months pre- and post-index. Cohorts were propensity score-matched (1:1) on demographics, comorbidities, and antidiabetic medications. Outcomes included changes in left ventricular ejection fraction (LVEF), HCRU, and costs.
RESULTS: 45,384 initiated SGLT-2i and 11,082 initiated DPP-4i. Most were >60 years (77.7%) with similar gender distribution (~47% female). Compared with DPP-4i users, SGLT-2i users had fewer inpatient admissions and emergency visits, slightly higher outpatient visits, and markedly lower inpatient costs (approximately one-third less). Emergency room costs were ~15% lower, while pharmacy costs were higher for SGLT-2i users. Overall healthcare costs were lower for SGLT-2i users ($71,390 vs $80,647). HF-specific analyses showed more outpatient HF visits but reduced HF-related inpatient costs among SGLT-2i users.
CONCLUSIONS: Compared with DPP-4 inhibitors, SGLT-2 inhibitor initiation in T2DM patients with heart failure showed lower acute care utilization and overall costs, supporting further evaluation of its role in cost-effective care.
METHODS: A retrospective cohort study was conducted using Optum® Market Clarity claims and EHR data (Jan 2017-Jun 2025). Adults (≥18 years) with T2DM and a new HF diagnosis (ICD-10 codes) were included. Exclusions were type 1 or gestational diabetes, concurrent use of both drug classes, or prior use during the pre-index period. The index date was the first prescription refill for SGLT-2i or DPP-4i. Patients required ≥12 weeks of therapy or ≥3 refills (PDC ≥80%) and continuous eligibility for 12 months pre- and post-index. Cohorts were propensity score-matched (1:1) on demographics, comorbidities, and antidiabetic medications. Outcomes included changes in left ventricular ejection fraction (LVEF), HCRU, and costs.
RESULTS: 45,384 initiated SGLT-2i and 11,082 initiated DPP-4i. Most were >60 years (77.7%) with similar gender distribution (~47% female). Compared with DPP-4i users, SGLT-2i users had fewer inpatient admissions and emergency visits, slightly higher outpatient visits, and markedly lower inpatient costs (approximately one-third less). Emergency room costs were ~15% lower, while pharmacy costs were higher for SGLT-2i users. Overall healthcare costs were lower for SGLT-2i users ($71,390 vs $80,647). HF-specific analyses showed more outpatient HF visits but reduced HF-related inpatient costs among SGLT-2i users.
CONCLUSIONS: Compared with DPP-4 inhibitors, SGLT-2 inhibitor initiation in T2DM patients with heart failure showed lower acute care utilization and overall costs, supporting further evaluation of its role in cost-effective care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO48
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)