OBJECTIVES: This study aimed to evaluate health expenditure and health-related quality of life (HRQoL) between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 agonists), either alone or with metformin, as recommended by the 2024 American Diabetes Association guidelines for type 2 diabetes (T2DM) patients with cardiovascular or kidney risks where limited evidence comparing economic burden and HRQoL exists.

METHODS: This observational cross-sectional study utilized payer’s and self perspectives and data from 2017-2021 Medical Expenditure Panel Survey, included T2DM patients (≥ 18 years) on SGLT2i, GLP-1 agonists, or in combination with metformin. HRQoL was assessed using physical (PCS) and mental component summary (MCS) based on Veterans Rand 12. Survey-weighed expenditures included out-of-pocket (OOP) prescription payments, and total healthcare expenditures. Propensity score matching was performed to control selection bias. Mann-Whitney U test was used to compare health expenditures and HRQoL between treatments.

RESULTS: Preliminary analysis showed GLP-1 agonists had significantly higher OOP payments than SGLT2i before (median: $106.96 vs. $45.90, P <0.01) and after excluding zero payments (median: $175.00 vs. $81.00, P <0.01). No significant difference was observed for total healthcare expenditures (median: $14,623.14 vs. $16,350.67, P = 0.14), MCS (median: 53.48 vs. 52.41, P = 0.40), or PCS (median: 44.54 vs. 45.22, P=0.19).

OOP payments for metformin with GLP-1 agonists were significantly higher than with SGLT2i before (median: $123.00 vs. $80.06, P <0.01) and after excluding zero payments (median: $150.00 vs. $107.33, P <0.01).No significant difference was observed for total healthcare expenditure (median: $13,844.73 vs. $15,628.00, P = 0.03), MCS (median: 54.30 vs. 54.19, P = 0.64), or PCS (median: 46.08 vs. 45.69, P=0.55).

CONCLUSIONS: Lack of significant difference in PCS or MCS between GLP-1 agonists and SGLT2i raises concerns, since GLP-1 agonists have higher OOP payments.Larger sample size is recommended to further investigate long-term impact on HRQoL and clinical outcomes.