CARDIOVASCULAR TREATMENT EFFECTS OF SGLT2 INHIBITORS AND GLP-1 RECEPTOR AGONISTS IN TYPE 2 DIABETES: A SYSTEMATIC REVIEW OF ECONOMIC MODELING APPROACHES
Author(s)
Luke Paterson, MSc1, Miriam Lucar Flores, MSc2, Gabriel Rogers, BA3, Philip Clarke, PhD2, Amanda Adler, MD, PhD4, Michael Willis, PhD5, Helen Dakin, DPhil6, José Leal, DPhil1.
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom, 2Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom, 3Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom, 4Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom, 5The Swedish institute for Health Economics (IHE), Lund, Sweden, 6University of Oxford, Oxford, United Kingdom.
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom, 2Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom, 3Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom, 4Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom, 5The Swedish institute for Health Economics (IHE), Lund, Sweden, 6University of Oxford, Oxford, United Kingdom.
OBJECTIVES: Simulation models are widely used to estimate the lifetime cost-effectiveness of interventions for type 2 diabetes. However, contemporary therapies, for example SGLT2 inhibitors and GLP-1 agonists, may exert treatment effects not fully captured by traditional risk factors (i.e. glycated haemoglobin (HbA1c)) used within simulation models, leading to misestimation of treatment benefit. We assessed the modelling approaches used to capture treatment effects in economic evaluations and the impact on cost-effectiveness.
METHODS: We conducted a systematic review of economic evaluations of SGLT2 inhibitors, GLP-1 agonists, and dual GIP/GLP-1 agonists over the lifetime horizon in people with type 2 diabetes. Studies were identified through bibliographic databases, health technology assessment repositories, and citation chasing. Modelling approaches were classified according to how treatment effects were represented: risk-factor only, hazard ratios (HRs)-only, risk-factor plus HRs, new risk equations, or hybrid approaches. We explored the impact on cost-effectiveness for studies conducting sensitivity analyses with and without additional cardiovascular effects. We also undertook exploratory multivariable linear regression to assess the association between modelling approaches and incremental QALYs.
RESULTS: 103 studies met the eligibility criteria. Modelling approaches were risk-factor only (57%, n=59), HRs-only (21%, n=22), and risk-factor plus HRs (22%, n=22). Few studies discussed methodological limitations, including the potential for double-counting treatment benefits. Within-study analyses suggested that accounting for additional cardiovascular effects generally increased QALYs, although the magnitude and impact on cost-effectiveness conclusions varied considerably. Exploratory between-study regressions showed a similar pattern, with approaches incorporating HRs associated with numerically larger incremental QALYs than risk-factor only approaches. However, there was substantial between-study variation.
CONCLUSIONS: Accounting for cardiovascular treatment effects beyond conventional risk factors may materially affect cost-effectiveness estimates for contemporary type 2 diabetes therapies. The field needs validated methods for isolating direct cardiovascular effects from risk-factor effects to support decision-making.
METHODS: We conducted a systematic review of economic evaluations of SGLT2 inhibitors, GLP-1 agonists, and dual GIP/GLP-1 agonists over the lifetime horizon in people with type 2 diabetes. Studies were identified through bibliographic databases, health technology assessment repositories, and citation chasing. Modelling approaches were classified according to how treatment effects were represented: risk-factor only, hazard ratios (HRs)-only, risk-factor plus HRs, new risk equations, or hybrid approaches. We explored the impact on cost-effectiveness for studies conducting sensitivity analyses with and without additional cardiovascular effects. We also undertook exploratory multivariable linear regression to assess the association between modelling approaches and incremental QALYs.
RESULTS: 103 studies met the eligibility criteria. Modelling approaches were risk-factor only (57%, n=59), HRs-only (21%, n=22), and risk-factor plus HRs (22%, n=22). Few studies discussed methodological limitations, including the potential for double-counting treatment benefits. Within-study analyses suggested that accounting for additional cardiovascular effects generally increased QALYs, although the magnitude and impact on cost-effectiveness conclusions varied considerably. Exploratory between-study regressions showed a similar pattern, with approaches incorporating HRs associated with numerically larger incremental QALYs than risk-factor only approaches. However, there was substantial between-study variation.
CONCLUSIONS: Accounting for cardiovascular treatment effects beyond conventional risk factors may materially affect cost-effectiveness estimates for contemporary type 2 diabetes therapies. The field needs validated methods for isolating direct cardiovascular effects from risk-factor effects to support decision-making.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR6
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Urinary/Kidney Disorders