OBJECTIVE: Cardiovascular mortality is leading cause of premature deaths in Indian adult-population. A national health-policy goal aims to achieve 25% reduction in premature deaths, by 2025. Interventions aimed at patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), are essential for this goal. Treatment with empagliflozin is indicated as well as recommended for such use. This research aims to assess cost-implications of empagliflozin use in patients with T2DM and CVD, across major public-health settings in India.

METHODS: A budget-impact analysis was performed in representative institutional settings of:

• Central Government Health Scheme (CGHS)
• Defence
• State-government (representative medical-colleges from West-Bengal state)
• Railways
• Employee State Insurance Corporation (ESIC)

Primary analysis was based on the following assumptions:

• Patients: Similar to EMPA-REG OUTCOME study participants
• Treatment-duration: 3-years
• Outcomes: Total cardiovascular and kidney events
• Clinical-benefit: As observed in EMPA-REG OUTCOME study
• Disease-burden and resource-utilization: As determined for each institution, with validation from respective care-providers
• Cost-savings with the use of empagliflozin, were estimated

RESULTS: Relative cost-savings of 3.4-5.1% were observed with empagliflozin use, across different institutional settings, as follows:

• State-government: 3.4%
• Railways: 3.5%
• ESIC: 4.4%
• Defence: 5.1%
• CGHS: 5.1%

Incremental relative cost-savings were observed over treatment-duration, ranging from 0.6-2.6% in first year, to 6.0-7.6% in third year.

In sensitivity analysis that excluded recurrent major cardiovascular events, relative cost-savings of 2.6-4.4% were observed.

Empagliflozin use resulted in per-patient cost-savings, across the different institutional settings, as follows:

• CGHS: INR 11,965
• Defence: INR 11,890
• ESIC: INR 9,962
• Railways: INR 7,529
• State-government: INR 7,128

Per-patient cost-savings of INR 7-12 thousand, represents 1.2 to 2.1 times the value of national per-capita health-expenditure.

CONCLUSIONS: This analysis supports cost-effective adoption of empagliflozin across Indian public healthcare settings, for optimizing access to patients with T2DM and CVD, as well as significant cost-savings in institutional health-expenditure for such patients.