OBJECTIVES

: In the cardiovascular outcome trials (CVOTs) EMPA-REG OUTCOME, TECOS and SAVOR-TIMI 53, empagliflozin (SGLT-2 inhibitor), sitagliptin and saxagliptin (both DPP-4 inhibitors) + 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 sitagliptin + SoC and saxagliptin + 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 outcomes from 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 sitagliptin and saxagliptin. HbA1c progression for all arms was projected based on the EMPA-REG OUTCOME trial. The effects of the CVOTs were applied up until treatment switch (reaching HbA1c of 8.5%) after which, the UKPDS82 risk equations predicted events based on physiological parameters. Basal-bolus rescue therapy was assumed after reaching an HbA1c of 8.5%. UK event costs and quality of life data were taken from literature. Drug costs were from the British National Formulary and Monthly Index of Medical Specialities. Discounting of 3.5% was applied.

RESULTS

: CDM projected 5.923, 5.462, and 5.324 quality-adjusted life-years (QALYs) and 51,629GBP, 48,306GBP and 48,885GBP total lifetime costs for empagliflozin, sitagliptin and saxagliptin, respectively. The incremental cost-effectiveness ratio of empagliflozin versus sitagliptin and saxagliptin was 7,209GBP/QALY and 4,582GBP/QALY, respectively. One-way and probabilistic sensitivity analyses showed robustness of the results.

CONCLUSIONS

: The results of this cost effectiveness analysis suggested that empagliflozin + SoC was cost-effective compared to sitagliptin + SoC and saxagliptin + SoC at a willingness to pay threshold of 20,000GBP/QALY.