The Net Monetary Benefit of Introducing Sodium-Glucose Cotransporter-2 Inhibitors in Middle-Income Countries
Author(s)
Falavigna M1, Deyneli O2, Seyam A3, Mustafa N4, Giorgi M5, Gabriel Z6, Goncalves S7, Solorzano J8, Vasnawala H9, Schabert V10, Mihajlović J11
1HTAnalyze Consulting and Training, Porto Alegre, RS, Brazil, 2Koç University School of Medicine, Istanbul, Turkey, 3Universal Health Insurance Authority (UHIA), Cairo, Egypt, 4Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, 5Instituto Universitario CEMIC, Buenos Aires, B, Argentina, 6AstraZeneca, Luton, UK, 7AstraZeneca, Buenos Aires, Argentina, 8AstraZeneca, San José, Costa Rica, 9AstraZeneca, Bengaluru, India, 10Epilogix LLC, Sarajevo, MD, Bosnia and Herzegovina, 11Mihajlović Health Analytics, Novi Sad, Serbia
Presentation Documents
OBJECTIVES: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce macrovascular complications and prolong survival in patients with type 2 diabetes (T2D); however, access to SGLT2i can be limited, particularly in some low- and middle-income countries (MICs). Our objective was to quantify the economic value of introducing SGLT2i in patients with T2D without complications in selected MICs.
METHODS: A cohort-level partitioned survival model was developed to quantify economic (from a national perspective) and clinical outcomes associated with the results of clinical cardiovascular outcome trials (CANVAS, EMPA-REG, DECLARE-TIMI 58) and real-world evidence (CVD-REAL 1&2 pooled) comparing SGLT2i with placebo or other glucose-lowering drugs (oGLD; standard of care), respectively. The model was applied over a time horizon of 20 years in six MICs with the following willingness-to-pay thresholds per incremental quality-adjusted life year (QALY), using the average exchange rate from Q4 2021: Argentina 18,306 US dollars (USD); Brazil 6,440 USD; Egypt 10,619 USD; Malaysia 31,372 USD; Mexico 27,231 USD; Turkey 18,157 USD. Data on healthcare resource utilisation, treatment costs and mortality were obtained for each country. The main outcome was net monetary benefit (NMB) per person.
RESULTS: A positive NMB for SGLT2i was observed across all countries. Using clinical trial data (versus placebo), we estimated the following 20-year NMB/person: Argentina 2,138 USD; Brazil 1,477 USD; Egypt 1,561 USD; Malaysia 11,685 USD; Mexico 15,029 USD; Turkey 3,811 USD. Based on real-world evidence (versus oGLD), 20-year NMBs were 1,571 USD, 2,918 USD, 3,469 USD, 19,985 USD, 13,796 USD and 7,328 USD, respectively. The positive NMBs resulted from increased QALYs and reductions in all-cause mortality in patients receiving SGLT2i.
CONCLUSIONS: Early introduction of SGLT2i in patients with T2D, either as add-on therapy or to replace an existing oGLD, is a cost-effective therapeutic option in MICs, with the potential to reduce the complications of T2D and increase quality of life.
Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Code
EE53
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas