OBJECTIVES: Despite emerging evidence suggesting multiple health benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in patients with diverse characteristics, whether health inequality exists after widely adopting SGLT2is in modern clinical practice remains unclear. To conduct distributional cost-effectiveness analyses (DCEAs) of using SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) by individual characteristics among Taiwanese patients with type 2 diabetes (T2D).

METHODS: A state-transition microsimulation model was applied to estimate healthcare costs and quality-adjusted life-years (QALYs) over 5 years in patient subgroups by age (<65 and ³65 years), estimated glomerular filtration rate (eGFR, 60≤eGFR<90 and ≥90 ml/min/1.73 m²), HbA1c (<8.5 and ≥8.5%), and body mass index (BMI, <30 and ≥30 kg/m²). The health inequality was estimated using the simulated costs, QALYs, inequality aversion index (10.95), one-time Taiwan's per-capita gross domestic product (USD 32,756 in 2022) as health opportunity cost, and proportion of patients receiving SGLT2is among those eligible for SGLT2is or DPP4is in Taiwan (16%), and these parameters were varied in one-way sensitivity analyses. The health inequality expressed in QALYs was the difference between population incremental equally-distributed-equivalent health and population incremental net health benefit (NHB).

RESULTS: With adopting SGLT2is over DPP4is, the population incremental NHB ranged from 2,010 QALYs (eGFR subgroups) to 3,391 QALYs (BMI subgroups) and the health inequality ranged from 75,552 QALYs (eGFR subgroups) to 151,012 QALYs (age subgroups), suggesting the enhancement of both efficiency and equity from using SGLT2is across subgroups. Results of sensitivity analyses were consistent with the primary findings. Notably, when assuming the increase of the proportion of patients receiving SGLT2is from 16% to 80%, the population incremental NHB substantially increased across all subgroups (e.g., an increase from 2,778 to 13,888 QALYs in age subgroups).

CONCLUSIONS: Adopting SGLT2is could increase population health and reduce health inequality across different patient characteristics in a real-world population with T2D.