OBJECTIVES: Sodium Glucose Transporter-2 Inhibitors (SGLT-2i) have demonstrated effectiveness in reducing heart failure (HF) hospitalizations in patients with type 2 diabetes (T2D) and HF with reduced ejection fraction (HFrEF). Diabetes guidelines recommend SGLT-2i therapy for HFrEF patients, however, SGLT-2i cost is a concern. We conducted a one-year cost-benefit analysis by modeling the use of SGLT-2i in reducing HF hospitalization in a < 65-year-old U.S. commercially insured population with T2D and HFrEF.

METHODS: Economic models included HF hospitalization rates from real-world data (RWD) and rate reductions from RWD and three SGLT-2i clinical trials. Real-world HF hospitalization rates by age group for patients with/without an SGLT-2i were obtained from Truven Commercial Database using claims data for U.S. patients with T2D and HFrEF with a prescription for metformin from 2012-2018. Perspectives were health-care sector and societal (productivity losses from hospitalization/ post-discharge recuperation/mortality). Sensitivity analyses considered 50% reductions in mortality rate and SGLT-2i prescription cost estimates.

RESULTS: Real-world HF rate reductions (by age group: 18-29/100%; 30-44/ 20.7%; 45-54/ 49.1%; 55-64/ 19.7%; overall/ 30.1%) varied, but were similar to trials (35%-49.0%). Mortality assumption was 22%. Calculated benefit-cost ratios were: health-care sector, RWD=0.26 vs trials=0.28-0.37; societal, RWD=2.23 vs trials=2.18-2.91. Greatest benefit-cost ratios were for 18-29 (health-care: RWD, 1.65, trials 0.60-0.80; societal: RWD 23.90, trials 8.43-11.21) and lowest for 55-64 (health-care: RWD, 0.16, trials 0.27-0.35; societal: RWD 0.89, trials 1.42-1.88). Reducing mortality assumption reduced societal benefit-cost ratios (RWD 1.46, trials 136-1.82). Reducing SGLT-2i cost 50% increased health-care benefit-cost ratios (RWD 0.52, trials 0.57-0.74); reducing SGLT-2i cost 72% generated positive trial ratios.

CONCLUSIONS: Societal benefits are substantive; health sector benefits are negative unless SGLT-2i cost is drastically reduced. SGLT-2i protective role in the setting of atherosclerotic cardiovascular disease and chronic kidney disease were not modeled in this analysis; inclusion of these benefits would likely increase SGLT-2i benefits.