OBJECTIVES : To compare cost of hospitalization due to heart failure (HHF) in type 2 diabetes mellitus (T2DM) patients with established cardiovascular disease (CVD) treated with canagliflozin vs non-SGLT2i antihyperglycemic agents (AHAs).

METHODS : Patients with T2DM and a diagnosis or procedure code indicating established CVD, who were initiated on AHAs, were selected from the Truven Commercial Claims and Encounters database (4/1/2013-5/15/2017). Matched (one to many) cohorts of patients starting on canagliflozin or non-SGLT2i AHAs were taken directly from OBSERVE-4D (NCT03492580), a real-world comparative effectiveness study of the risk of HHF associated with canagliflozin and other AHAs, also using the Truven database (methodology described in Ryan et al, Diabetes Obes Metab, 2018). HHF was defined as a hospitalization during the follow-up period with a primary diagnosis of heart failure (ICD-9 428.x, 402.11; ICD-10 I11.0, I27.81, I50.x, I97.11x, I97.13x, I97.7x, P29.0x). Follow-up period was censored at discontinuation of cohort-defining drug or start of a different non-metformin AHA. Per patient per month (PPPM) costs for HHF were compared between cohorts using generalized linear models with a log link function and gamma distribution.

RESULTS : The matched cohorts of canagliflozin (n=13,802) and non SGLT2i AHAs (n=44,203) were well-balanced on baseline characteristics, as previously published in Ryan et al. Mean age for the study population was 55.7 years old and 41.3% were female. Mean follow-up times on-treatment for the canagliflozin and non-SGLT2i AHA cohorts were 5.9 and 7.1 months, respectively. During follow-up, mean costs attributable to HHF (PPPM) were $2.00 for canagliflozin cohort and $13.74 for non-SGLT2i AHA cohort. Compared to canagliflozin, the mean incremental cost associated with non-SGLT2i AHAs was $11.74 (p-value<0.0001).

CONCLUSIONS : Among patients with T2DM and established CVD, the cost attributable to HF related hospitalization was significantly lower for patients initiating canagliflozin than patients initiating non-SGLT2i AHAs.