OBJECTIVES

We assessed the country-specific, real-world cost-effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) for type 2 diabetes (T2D) from the healthcare sector perspective.

METHODS

A Markov model comprising health states of myocardial infarction, stroke, heart failure, and cardiovascular or non-cardiovascular mortality was constructed to estimate the 30-year health and economic outcomes (i.e., life expectancy [LE], quality-adjusted life year [QALY], and healthcare cost) of SGLT2i and DPP4i users, discounting costs and effectiveness at 3% annually. The costs and health utilities related to health states were obtained from published studies of Taiwanese T2D populations. The effectiveness parameters (e.g., transition probabilities between different health states) were estimated using Taiwan’s National Health Insurance Research Database and drawn from published literature. Costs were expressed in 2020 USD. The incremental cost-effectiveness ratios (ICERs) measured as the incremental cost per LE or QALY gained for SGLT2is versus DPP4is were presented and against the willingness-to-pay (WTP) threshold defined as 1-3 times of Taiwan’s gross domestic production ($30,038 – $90,114).

RESULTS

The base-case analysis showed that over 30 years, using SGLT2is versus DPP4is approximately cost $2,751 more and gained 0.94 more QALY (ICER: $2,938/QALY gained). Results of one-way sensitivity analyses revealed that the cost-effectiveness results were most sensitive to the annual drug cost of DPP4is, relative hazard for death of SGLT2is versus DPP4is, discounting rate, relative hazard for heart failure of SGLT2is versus DPP4is, and event rate of heart failure in DPP4i users. The probabilistic sensitivity analysis showed the use of SGLT2is being favored in 100% of model iterations at the pre-defined WTP threshold.

CONCLUSIONS

Using SGLT2is was demonstrated to be highly cost-effective in real-world practice, which may promote them as an economically reasonable alternative to DPP4is in routine care for T2D in Taiwan.