OBJECTIVES: SGLT2 inhibitors and DPP4 inhibitors have similar efficacy and cardiovascular outcomes profile. They are both relatively safe and tolerable and also have reduced risk of hypoglycemia compared to other anti-diabetic medications. Comparative effectiveness of these classes has been limited to clinical trials with paucity of real world utilization data that compare these two classes as a whole. The primary objective of this study was to compare the overall health expenditures of diabetic patients on SGLT2 inhibitors vs DPP4 inhibitors.

METHODS: Two cohorts of diabetic patients receiving either SGLT2 inhibitor or DPP4 inhibitor were identified from 2015 Medical Expenditure Panel Survey (MEPS) database. Propensity score matching technique was used to balance the cohorts based on age, gender, race, ethnicity, income, education, insurance status, employment status, and comorbidity score. Patients in the SGLT2 inhibitor cohort were matched against the patients in DPP4 inhibitor cohort using a 1:2 ratio on the logit of propensity score using caliper width of 0.1 of the standard deviation of the logit of the propensity score. Total health expenditures between the two groups were compared using t-test.

RESULTS: A total of 379 patients were identified who use either a DPP4 inhibitor (n = 290) or SGLT2 inhibitor (n= 89). After propensity score matching, a total of 240 patients were left in the sample with 80 patients in the SGLT2 inhibitor cohort and 160 patients in the DPP4 inhibitor cohort. The average annual total health expenditure was slightly (nonsignificant) higher in the SGLT2 inhibitor cohort vs DPP4 inhibitor cohort ($ 17,296.40 vs $ 15,666.70 respectively p = 0.6131)

CONCLUSIONS: Both SGLT2 inhibitors and DPP4 inhibitors have similar average total health expenditure