OBJECTIVES

: In the cardiovascular outcome trials (CVOTs) EMPA-REG OUTCOME, and LEADER, empagliflozin (SGLT-2 inhibitor), and liraglutide (GLP-1) + standard of care (SoC) were compared to SoC (placebo arm in the trial) in patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD). This study assessed the cost-effectiveness of empagliflozin+SoC in comparison to liraglutide+SoC in patients with T2D and established CVD based on the respective CVOTs using the UK National Health Service (NHS) perspective.

METHODS

: The IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the clinical event rates observed in the EMPA-REG OUTCOME trial. Baseline characteristics and observed effects on physiological parameters (HbA1c, BMI, blood pressure, lipids) were used as inputs. Network meta-analysis provided the relative risks for cardiovascular outcomes with empagliflozin versus liraglutide. Microvascular outcomes were predicted by standard CDM risk equations. The relative treatment effect on the CVOTs was assumed for five years, the modelling horizon of the analysis. The CDM was populated with UK event costs and quality of life data taken from literature. Drug costs were from the British National Formulary and Monthly Index of Medical Specialities. Discounting of 3.5% was applied.

RESULTS

: Over a 5-year time horizon, CDM projected 2.608 and 2.506 QALY and 14,473GBP and 18,820GBP total costs for empagliflozin+SoC and liraglutide+SoC, respectively, making empagliflozin+SoC the dominant strategy. Projected mortality rate was 10.52% for empagliflozin+SoC and 13.26% for liraglutide+SoC. Myocardial infarction rate was comparable (6.10% vs. 6.14%), non-fatal stroke rate was higher (3.42% vs. 2.43%) and heart failure rate was lower in the empagliflozin arm (5.79% vs. 7.66%) compared to the liraglutide arm. One-way and probabilistic sensitivity analyses showed robustness of the results.

CONCLUSIONS

: Based on the results of the CVOTs, cost effectiveness analysis suggested that empagliflozin+SoC was dominant compared to liraglutide+SoC from the UK NHS perspective over a 5-year time horizon.