OBJECTIVES: This analysis evaluated the cost-effectiveness of the sodium-glucose co-transporter-2 inhibitors empagliflozin vs dapagliflozin in patients with T2DM and established CV disease from a US payer’s perspective.

METHODS: A discrete-event simulation economic model was developed to estimate clinical and cost consequences of CV events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, and hospitalization for heart failure [HHF]) over patients’ lifetimes. Occurrence of CV events in EMPA-REG OUTCOME were estimated based on event-free survival curves with time-dependent covariates. A hazard ratio with 95% confidence intervals for dapagliflozin vs empagliflozin on each modeled event was estimated from published DECLARE-TIMI 58 data and the EMPA-REG OUTCOME trial using an indirect treatment comparison. US costs and utilities were taken from public sources.

RESULTS: Compared with dapagliflozin, empagliflozin was associated with a mean incremental health benefit of 0.51 quality-adjusted life years (QALYs) and an incremental cost of $264, yielding an incremental cost-effectiveness ratio (ICER) of $514/QALY. Results were driven by lower CV death events per 100 patient-years with empagliflozin (1.62) vs dapagliflozin (2.18), resulting in 1.16 life-years gained. The incremental cost was minimal given total medical cost savings per patient was $1,476 and the additional drug acquisition cost was $1,741. Sensitivity analysis showed that results were insensitive to variation in most parameters. Empagliflozin dominated dapagliflozin in several scenarios, including a reduced model time horizon of only 10 years. The ICER was below a willingness-to-pay threshold of $50,000/QALY in every replication of a probabilistic sensitivity analysis.

CONCLUSIONS: Empagliflozin added to SoC represents a highly cost-effective use of health care resources compared with dapagliflozin added to SoC in patients with T2DM and established CV disease in the US.