OBJECTIVES

Cost of diabetes drugs is the largest item on the primary care drug budget in Denmark. Clinical guidelines recommend a sodium-glucose co-transporter-2 (SGLT2) inhibitor or GLP-1 receptor agonist as second-line treatment after metformin in people with type 2 diabetes (T2D) and established cardiovascular disease (CVD). In Denmark, empagliflozin and liraglutide are the most used in their respective classes. This study assessed the cost-effectiveness of empagliflozin+standard of care (SoC) in comparison to liraglutide+SoC in people with T2D and established CVD from a Danish perspective.

METHODS

The IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the clinical event rates observed in the EMPA-REG OUTCOME trial. Baseline characteristics and observed effects on physiological parameters (HbA1c, BMI, blood pressure, lipids) were used as inputs. Network meta-analysis provided the relative risks for cardiovascular outcomes with empagliflozin versus liraglutide. Standard CDM transition probabilities drove microvascular outcomes. The relative treatment effect was assumed for nine years, after which patients were assumed to switch therapy to insulin basal bolus. The CDM was populated with Danish event costs and quality of life data from literature. Drug costs were pharmacy purchase prices ex. VAT. Discounting of 4% was applied.

RESULTS

Over a lifetime horizon, CDM projected 9.858 and 9.667 life years, 6.162 and 5.976 QALY and DKK 478,026 (€16,543) and DKK 500,025 (€21,687) total costs for empagliflozin and liraglutide both plus SoC, respectively, therefore empagliflozin+SoC is the dominant strategy (providing cost savings for additional QALY). Taking a 5-year perspective, empagliflozin+SoC remained dominant. One-way and probabilistic sensitivity analyses showed robustness of the results.

CONCLUSIONS

This cost-effectiveness analysis suggests that empagliflozin+SoC is dominant compared to liraglutide+SoC from the Danish perspective both at short and long-term.