OBJECTIVES: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, has been used to treat individuals with type 2 diabetes mellitus (T2DM). Another SGLT-2 inhibitor, ertugliflozin, was recently approved for these patients. The purpose of this study was to conduct an economic evaluation of empagliflozin compared to ertugliflozin.

METHODS: A Markov model was developed with the defined health states (e.g., diabetes alone, diabetes combined with complications such as myocardial infection, stroke, hospitalizations for heart failure, and coronary revascularization) that are commonly observed in patients with T2DM. Effectiveness was estimated using quality-adjusted life years (QALYs). We adopted the US payer perspective, including direct costs only. A lifetime horizon was selected. Transition probabilities, costs, and utilities were derived from clinical studies and published literature. An incremental cost-effectiveness ratio (ICER) was estimated as a ratio of the difference in costs to the difference in QALYs between these two drugs. A discount rate of 5% was applied to both costs and consequences. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: Results from base-case analysis showed higher lifetime accumulated costs ($190,635 and $154,725) and lower accumulated effectiveness (6.12 QALYs and 6.18 QALYs) of empagliflozin compared to ertugliflozin. Patients with ertugliflozin were projected to experience fewer events of heart failure, stroke and revascularization procedure over lifetime horizon but higher event rate for myocardial infarction. The calculated ICER indicated that ertugliflozin was less costly and more effective compared to empagliflozin. Results from sensitivity analyses indicated the base-case results were robust to variations of all assumptions and input parameters.

CONCLUSIONS: Results from cost-effectiveness analysis suggested that ertugliflozin was dominant compared to empagliflozin from US payer perspective over a lifetime horizon.