OBJECTIVES: Non-severe hypoglycemia episodes (NSHEs) are associated with clinical adverse outcomes, a lower health-related quality of life, an increased burden of disease and reduced work productivity. The objective of this study was to estimate prevalence of NSHEs and associated economic outcomes attributable to SU versus SGLT-2 inhibitor initiation after metformin over one year for Canadian patients with type 2 diabetes (T2DM).

METHODS: Risk Difference for NSHEs was calculated for SU and SGLT2-I from RCTs data. Estimation of NSHEs attributable to SU utilization in Canada was calculated from published data. Both direct and indirect costs associated with NSHEs were obtained from previous published studies in literature.

RESULTS: Number of patients with T2DM and exposure to SU in Canada in 2016 was estimated to be 1,246,438. The average underreported NSHEs in clinical settings was estimated at 67.7%. Risk Difference for NSHEs for SU versus SGLT2-I was estimated at 26.7%. Estimation of excess NSHEs attributable to SU utilization versus SGLT2-I in Canada was estimated at 130,434 events per year [sensitivity analysis: Minimum 80,680 and Maximum 624,465]. Total indirect costs including loss of work productivity and out of pocket costs secondary to excess NSHEs due to SU utilization versus SGLT2-I after metformin was estimated CDN$8.6M (M=millions) for 2016 [sensitivity analysis: Minimum CDN$5.3M and Maximum CDN$81.2M].

CONCLUSIONS: NSHEs, which is a forgotten variable in economic evaluations for healthcare reimbursement models, occur frequently in real world clinical settings but are infrequently reported. NSHEs can lead to a significant loss of work productivity and out of pocket costs.