OBJECTIVES

Sodium-glucose cotransporter (SGLT) 2 inhibitors (and combined SGLT1/2 inhibitors) are a relatively new class of anti-hyperglycemic drugs that decrease renal glucose reabsorption, thereby promoting glucose excretion in the urine (glucosuria). SGLT2 inhibitors have been shown to improve glycemic control in patients with type 2 diabetes with no increase in hypoglycemia. Based on a recent meta-analysis of SGLT2 and SGLT1/2 inhibitors, the objective of the present study was to evaluate the cost-utility of adding SGLT inhibitors to insulin in patients with type 1 diabetes (T1D) in the UK.

METHODS

The PRIME Diabetes Model, a published and validated online model of T1D, was used to evaluate the cost-utility of adding SGLT inhibitors to a basal-bolus insulin regimen from the perspective of a UK healthcare payer. Treatment effects were taken from a recent meta-analysis and baseline cohort characteristics were based on a large-scale SGLT1/2 inhibitor trial. Quality of life utilities and UK-specific costs were identified from the literature, with costs expressed in 2017 pounds sterling (GBP). Future cost and effectiveness outcomes were discounted at 3.5% per annum and one-way and probabilistic sensitivity analyses were conducted.

RESULTS

Over a 60-year time horizon, adding SGLT inhibitors to a basal-bolus insulin regimen improved quality-adjusted life expectancy (QALE) by 0.10 quality-adjusted life years (QALYs), from 12.16 QALYs with insulin alone to 12.26 QALYs with insulin and an SGLT inhibitor. The improvement in QALE was accompanied by an increase in costs of GBP 1,915 from GBP 41,090 to GBP 43,005, resulting in an incremental cost-utility ratio of GBP 18,776 per QALY, falling below a willingness-to-pay threshold of GBP 20,000 per QALY.

CONCLUSIONS

Based on data from a recent meta-analysis, a PRIME Diabetes Model analysis showed that addition of SGLT inhibitors to a basal-bolus insulin regimen in patients with T1D would be considered cost-effective from the perspective of a UK healthcare payer.