OBJECTIVES: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce deaths and cardiovascular events in patients with type 2 diabetes mellitus (T2DM), but are currently not used as first-line therapy. This study aimed to evaluate the cost-effectiveness of first-line empagliflozin combined with metformin versus first-line metformin monotherapy (current standard of care) among Australian patients with existing cardiovascular disease (CVD) and newly diagnosed T2DM.

METHODS: A decision-analytic Markov model was constructed to simulate the risk of myocardial infarction, stroke, hospitalisation for heart failure or angina and deaths among Australians with CVD and newly diagnosed T2DM. Cycles were one year and the time horizon was five years. Efficacy data for SGLT2 inhibitors was based on results of the EMPA-REG OUTCOME trial. Data regarding the prevalence of T2DM and CVD, use of medications, costs and utilities were also drawn from published sources. The evaluation adopted both a healthcare and societal perspective, the latter ascribing the Australian Government’s ‘value of statistical life year’ (VoSLY, AUD$213,000) to each year lived by an Australian. Future outcomes were discounted at a rate of 5% per annum.

RESULTS: Over the five-year time horizon, first-line use of empagliflozin was predicted to reduce the overall risk of cardiovascular events by 0.94%, and of death by 6.53%. There would be a gain of 0.185 years of life and 0.141 quality-adjusted life years (QALYs) per person), at a net health system cost of AUD $4155 per person. These equate to incremental cost-effectiveness ratios of AUD $22,251 per year of life saved and AUD $29,558 per QALY saved. The gains in VoSLY amounted to $39,301 per person, meaning that from a societal perspective, the intervention would be cost-saving.

CONCLUSIONS: First-line empagliflozin (combined with metformin) represents a cost-effective strategy for the management of Australians with CVD and newly-diagnosed T2DM.