OBJECTIVES

: A good glycemic control reduces the risk for diabetes-related complications in patients with type 2 diabetes (T2DM). However, achieving this goal may require individualized pharmacological approaches. This study aimed to compare direct healthcare cost in patients treated with empagliflozin (EMPA) compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonists (GLP-1-RA).

METHODS

A retrospective study was conducted based on German claims data (GWQ) covering the years 2014-2018. Continuously insured persons with at least two outpatient diagnoses and/or one inpatient diagnosis of T2DM were included if they started treatment with EMPA, DPP-4i or GLP-1-RA in 2015-2018. Patients were matched by propensity scores and were followed from the date of the first prescription until end of data availability, censoring for death or therapy discontinuation. Inpatient, outpatient and medication all-cause costs were assessed from the perspective of a statutory health insurance.

RESULTS

: Of 24,465 patients included, 3,285 received EMPA, 19,443 DPP-4i, and 1,747 GLP-1-RA. Matched cohorts were balanced on baseline characteristics (EMPA vs. DPP-4i: n₁/n₂ 3,100/3,100; mean age 60.0/59.7 years; female 34.0%/33.5%; and EMPA vs. GLP-1-RA: n₃/n₄ 1,346/1,346; mean age 56.4/56.7 years; female 41.7%/39.8%).

Mean total costs per patient after start of DPP-4i were €7,009 (95%-CI: 6,573-7,444) vs. €4,274 (3,982-4,566) for EMPA. Cost difference between DPP-4i and EMPA treatment was driven by inpatient cost (€1,560), outpatient cost (€427), and drug cost (€723); all differences reach significance.

Costs associated with GLP-1-RA treatment were also significantly higher compared with EMPA (€6,851 [6,183-7,518] vs. €4,895 [4,345-5,445]). While inpatient costs did not differ significantly (€549), lower expenses resulted from lower outpatient cost (€264) and lower drug cost (€1,143).

CONCLUSIONS

: EMPA represents a cost-effective alternative to DPP-4i and GLP-1-RA for patients with T2DM. While lower costs associated with EMPA versus DPP-4 mainly result from less frequent hospitalizations, cost savings in comparison to GLP-1-RA are explained by lower drug cost.