OBJECTIVES: Complications of diabetes account for major burden of direct healthcare costs to the patient and household. Average per-patient expenditure for diabetes-care in India, is estimated to be INR 13,179 per year. In patients with type-2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), empagliflozin use has proven meaningful risk-reduction for cardiovascular outcomes and death, and is indicated as well as recommended for such use.

The objective is to assess cost-implications of empagliflozin use, in patients with T2DM and CVD, in a non-reimbursed private-hospital setting in India.

METHODS: Cost-effectiveness and budget-impact analysis was performed for the representative patient-population, with resource-utilization estimates derived from a privately managed tertiary-care hospital (Fortis hospital, Kolkata).

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 from reference hospital, and validated by respective care-providers
• Outcomes analysed: Relative and Absolute cost-savings associated with the use of empagliflozin, in comparison to conventional standard of care without empagliflozin

RESULTS: Empagliflozin use resulted in an estimated cost-saving of 4.9%, relative to conventional standard of care.

Incremental relative cost-saving was observed over treatment-duration, ranging from 2.9% in first year, to 6.8% in third year.

In sensitivity analysis that excluded recurrent major cardiovascular events, relative cost-saving of 2.7% was observed.

Empagliflozin use resulted in per-patient cost-saving of INR 19,407 over 3 years.

Whereas hospital-costs are reduced by 4.9%, the average annual per-capita expenditure may be reduced by 28.4% in 1-year, and by 51% in 3-years, in the eligible patients.

CONCLUSIONS: This analysis suggests that despite being an out-of-pocket expenditure, empagliflozin is a cost-effective intervention for eligible patients with T2DM and CVD, in the private healthcare setting of India.