Presentation (CTI)

OBJECTIVES: Objectives: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with diabetes. Both GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2is) have demonstrated cardiovascular benefits in clinical trials, yet their comparative cost-effectiveness in real-world practice remains underexplored. This study evaluates the economic and clinical outcomes of GLP-1 RAs versus SGLT2is using nationally representative U.S. data.
METHODS: Using the 2022 Medical Expenditure Panel Survey (MEPS) Full-Year Consolidated and Prescribed Medicines files, we identified adults with diabetes treated with GLP-1 RAs or SGLT2is. Propensity score matching and regression models were applied to control for baseline imbalances. Outcomes included total medical expenditures and cardiovascular events. Incremental cost-effectiveness ratios (ICERs) were estimated, with bootstrap sensitivity analyses conducted to test robustness.
RESULTS: GLP-1 RA users had lower rates of cardiovascular events than SGLT2 users (25.96% vs. 34.62%), corresponding to a 40% reduction in odds (p=0.058). Costs were higher for GLP-1 users ($23,811 vs. $22,201), though the difference was not statistically significant. The mean ICER was $27,624 per cardiovascular event prevented. Predictors of higher costs included older age (+$269 per year, p=0.001), while Hispanic (-$14,834, p=0.019) and Asian (-$16,006, p=0.016) patients had significantly lower expenditures, highlighting potential disparities. Sensitivity analyses confirmed uncertainty but supported key associations.
CONCLUSIONS: GLP-1 RAs may offer superior cardiovascular protection compared to SGLT2is with modest, statistically insignificant cost increases. The ICER suggests potential cost-effectiveness within accepted U.S. thresholds. These findings have global relevance for formulary decisions, payer negotiations, and policies to improve equitable access to advanced diabetes therapies.