OBJECTIVES: Whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or sodium-glucose co-transporter 2 inhibitors (SGLT2is) are cost-effective when considering solely their cardiorenal benefits is unknown. We projected the incidence and costs of hospitalisation for myocardial infarction (MI), stroke, and heart failure (HF), and end-stage kidney disease (ESKD) among people with type 2 diabetes under scenarios of widespread use of these drugs, from an Australian healthcare perspective.

METHODS: We designed a lifetable model using real world data that captured CVD and ESKD morbidity, and mortality from 2020-2040. Rates were derived via linking the Australian diabetes registry to hospital admissions databases, the National Death Index, and the ESKD registry using data from 2010-2019. We modelled four scenarios: GLP-1 RA (1) or SGLT2i (2) use among the entire population with type 2 diabetes; and GLP-1 RA (3) or SGLT2i (4) use among the entire secondary prevention population (i.e. people with type 2 diabetes and prior CVD). Outcomes of interest included quality adjusted life years (QALYs), total healthcare costs and the incremental cost-effectiveness ratio (ICER) compared to no use of either drug. We applied 5% annual discounting for health economic outcomes.

RESULTS: QALYs gained with GLP-1 RA and SGLT2i use in the entire population were 291,776 and 330,873, respectively, compared to no use of either drug. Net cost differences were AU$23.6 billion for GLP-1 RA and AU$7.6 billion for SGLT2i; ICERs: AU$80,901 and AU$23,032 per QALY gained, respectively. In secondary prevention, QALYs gained, net cost differences, and ICERs were 56,819, AU$3.3 billion, and AU$58,715 per QALY gained for GLP-1 RA and 64,918, AU$424 million, and AU$6,532 per QALY gained for SGLT2i, respectively.

CONCLUSIONS: At current prices, only SGLT2is, but not GLP-1 RAs, are cost-effective (at AU$50,000 per QALY) when considering only their cardio-renal benefits for people with type 2 diabetes.