OBJECTIVES: To assess healthcare costs and medication burden among metformin monotherapy users initiating empagliflozin vs. dipeptidyl peptidase-4 inhibitor (DPP4i) in Medicare and 2 US commercial claims datasets from 08/2014 to 09/2016.

METHODS: We identified a 1:1 propensity-score (PS)-matched cohort of type 2 diabetes (T2D) patients ≥18 years on metformin monotherapy starting either empagliflozin or DPP4i, controlling for ≥140 baseline covariates including clinical, healthcare resource utilization, and cost-related covariates, measured during the 1 year before add-on treatment initiation. We evaluated total (inpatient, outpatient and pharmacy) cost and medication burden among empagliflozin vs. DDP4i initiators during the follow-up period.

RESULTS: We identified a total of 2,928 1:1 PS-matched pairs from the three datasets, with well-balanced baseline characteristics, as measured by absolute standardized differences (aSD)<0.1. Mean age was 57 years, 45% were female, and mean HbA1C was 8.2%. Baseline mean total ($8,698 vs $8,980, aSD=0.01), inpatient ($1,265 vs $1,369, aSD=0.01), outpatient ($5,161 vs $5,222, aSD=0.00), and pharmacy ($2,239 vs $2,362, aSD=0.02) costs were balanced among empagliflozin vs DPP4i initiators, as well as mean number of distinct medication prescriptions.

During follow-up (mean 168 days), the PMPY total costs tended to be lower among empagliflozin vs. DDP4i initiators ($13,547 vs $14,902; Diff=-$1,355, 95%CI: -3,922, 991), as were inpatient ($1,502 vs $2,140 PMPY; Diff=-$638, 95%CI: -1,864, 484) and outpatient ($5,570 vs $6,300 PMPY; Diff=-$730, 95%CI: -2,500, 643) costs. Pharmacy costs ($6,442 vs $ 6,416 PMPY; Diff=$26, 95%CI: -914, 795) were not significantly different between the two groups. CV-related medical costs also tended to be lower (Diff=-$242, 95%CI: -1,641, 902) in empagliflozin initiators. The number of distinct medication prescriptions was similar (15.5 PMPY in both groups; Incidence rate ratio=1.01; 95% CI: 0.99,1.03).

CONCLUSIONS: Results showed trend towards lower total cost of care, driven by medical costs, and similar medication burden among metformin monotherapy users initiating empagliflozin vs DPP4i.