OBJECTIVES

Type 2 diabetes mellitus (T2DM) patients have considerably higher risks of cardiovascular (CV) morbidity and mortality, and are disproportionately affected by CV disease. Treatment with empagliflozin, a selective sodium glucose cotransporter-2 (SGLT-2) inhibitor, significantly reduces CV risk and mortality when administered in addition to standard of care. This study assessed the financial implications of providing empagliflozin to T2DM patients at increased CV risk in Tunisia from the perspective of the national health authorities.

METHODS

A budget impact model was developed to estimate the costs associated with the introduction of empagliflozin and its impact on health budgets over three years. The analysis was based on the results of the available clinical trial (EMPA-REG OUTCOME®). Drug costs were calculated from listed public prices weighted with projected market shares within each therapeutic class to reveal the average cost of treatment per class.

RESULTS

Over three years, the annual cost of empagliflozin raised from 17.9 to 53.9 million TND, while savings from 6.6 to 72.9 million TND were expected on insulin, driven by delaying progression to this line of treatment and reducing average insulin doses. In comparison, savings were also expected on all other treatments, although on smaller scales. The net budgetary impact showed a relative increase of 11.2 million TND in year 1, followed by a slight increase of 4.4 million TND in year 2, and then a drop of 20.2 million TND in year 3.

CONCLUSIONS

The introduction of empagliflozin in Tunisia could lead to substantial savings on healthcare budgets despite a relative increase in the drug budget in the first year of treatment (in the most conservative assumption where empagliflozin is added to existing patients’ treatments), the net budget difference is negative from the third year. Other more substantial savings on the costs of clinical events avoided would further contribute to projected cost reductions.