REAL-WORLD UTILIZATION, EXPENDITURES, AND CARDIOVASCULAR EVENTS AMONG USERS OF SGLT-2 INHIBITORS AND GLP-1 RECEPTOR AGONISTS IN US ADULTS WITH TYPE 2 DIABETES
Author(s)
Albaraa M. Alwafi, PharmD, MS1, Fatimah Sherbeny, MS, PharmD, PhD2, Askal Ayalew Ali, PhD3, Sandra Suther, PhD3, Barry Bleidt, PhD3.
1King Abdullah Medical City, Makkah, Saudi Arabia, 2ESAP,COPPS Florida A&M University, Tallahassee, FL, USA, 3Florida A & M University, Tallahassee, FL, USA.
1King Abdullah Medical City, Makkah, Saudi Arabia, 2ESAP,COPPS Florida A&M University, Tallahassee, FL, USA, 3Florida A & M University, Tallahassee, FL, USA.
OBJECTIVES: To characterize real-world utilization trends, concurrent antidiabetic medication patterns, cardiovascular event prevalence, healthcare utilization, and expenditures among U.S. adults with type 2 diabetes mellitus (T2DM) using SGLT-2 inhibitors or GLP-1 receptor agonists.
METHODS: Using pooled Medical Expenditure Panel Survey (MEPS) data from 2017-2023, we identified adults aged >=18 years with documented T2DM (ICD-10-CM E11). Exclusive SGLT-2 inhibitor users and exclusive GLP-1 receptor agonist users formed the primary comparative cohort; dual users were excluded. Survey-weighted multivariable models, adjusted for predisposing, enabling, and need-related covariates from the Aday-Andersen Behavioral Model (age, sex, race/ethnicity, education, income, insurance, modified Charlson Comorbidity Index [CCI], survey year), estimated adjusted odds ratios (aOR) for binary outcomes and cost ratios (aCR) for expenditures, with SGLT-2 users as reference (complete-case N=2,844).
RESULTS: The descriptive sample included 17,010 person-year observations (approximately 176.3 million weighted person-years). GLP-1 receptor agonist utilization increased nearly fourfold, from approximately 1.4 million person-years in 2017 to 5.2 million in 2023, while SGLT-2 inhibitor use more than doubled (approximately 1.2 to 3.1 million); non-users remained the majority throughout. SGLT-2 users had higher baseline cardiovascular event prevalence (23.0% vs. 17.7%). After adjustment, GLP-1 users had lower odds of cardiovascular events (aOR=0.67, 95% CI 0.48-0.94), with no significant differences in emergency department (aOR=0.86) or inpatient (aOR=0.82) utilization. GLP-1 users incurred approximately 25% higher prescription expenditures (aCR=1.25, 95% CI 1.12-1.38), whereas total expenditures did not differ (aCR=1.05, p=0.430). Modified CCI was the most consistent predictor of acute care utilization.
CONCLUSIONS: In this nationally representative observational analysis, SGLT-2 inhibitor and GLP-1 receptor agonist use grew substantially during 2017-2023. GLP-1 use was associated with lower cardiovascular event odds-likely reflecting confounding by indication rather than comparative effectiveness-and higher prescription costs without higher total expenditures. Utilization was strongly associated with insurance, income, and education, highlighting socioeconomic disparities in access to newer guideline-recommended cardiometabolic therapies.
METHODS: Using pooled Medical Expenditure Panel Survey (MEPS) data from 2017-2023, we identified adults aged >=18 years with documented T2DM (ICD-10-CM E11). Exclusive SGLT-2 inhibitor users and exclusive GLP-1 receptor agonist users formed the primary comparative cohort; dual users were excluded. Survey-weighted multivariable models, adjusted for predisposing, enabling, and need-related covariates from the Aday-Andersen Behavioral Model (age, sex, race/ethnicity, education, income, insurance, modified Charlson Comorbidity Index [CCI], survey year), estimated adjusted odds ratios (aOR) for binary outcomes and cost ratios (aCR) for expenditures, with SGLT-2 users as reference (complete-case N=2,844).
RESULTS: The descriptive sample included 17,010 person-year observations (approximately 176.3 million weighted person-years). GLP-1 receptor agonist utilization increased nearly fourfold, from approximately 1.4 million person-years in 2017 to 5.2 million in 2023, while SGLT-2 inhibitor use more than doubled (approximately 1.2 to 3.1 million); non-users remained the majority throughout. SGLT-2 users had higher baseline cardiovascular event prevalence (23.0% vs. 17.7%). After adjustment, GLP-1 users had lower odds of cardiovascular events (aOR=0.67, 95% CI 0.48-0.94), with no significant differences in emergency department (aOR=0.86) or inpatient (aOR=0.82) utilization. GLP-1 users incurred approximately 25% higher prescription expenditures (aCR=1.25, 95% CI 1.12-1.38), whereas total expenditures did not differ (aCR=1.05, p=0.430). Modified CCI was the most consistent predictor of acute care utilization.
CONCLUSIONS: In this nationally representative observational analysis, SGLT-2 inhibitor and GLP-1 receptor agonist use grew substantially during 2017-2023. GLP-1 use was associated with lower cardiovascular event odds-likely reflecting confounding by indication rather than comparative effectiveness-and higher prescription costs without higher total expenditures. Utilization was strongly associated with insurance, income, and education, highlighting socioeconomic disparities in access to newer guideline-recommended cardiometabolic therapies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD118
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)