OBJECTIVES: The EMPA-REG-OUTCOME trial demonstrated that adding empagliflozin (a sodium-glucose cotransporter-2 inhibitor) to standard of care for patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease reduced the composite endpoint of cardiovascular death, myocardial infarction or stroke. We designed a budget impact model to evaluate the financial impact of adding empagliflozin to standard of care for these patients in the Netherlands.

METHODS: An Excel-based model with a 1–3-year flexible time horizon was designed from a payer perspective in the Netherlands. The model included all patients in the Netherlands with T2DM and established cardiovascular disease. It compared the annual drug acquisition and cardiovascular and renal management costs of treating these patients with standard of care alone or standard of care plus empagliflozin. Drug acquisition costs included those for empagliflozin and standard of care (glucose-lowering drugs, insulin and insulin care). Management costs included those associated with non-fatal myocardial infarction and stroke, unstable angina, heart failure, cardiovascular death, renal failure and macroalbuminuria development. Relative incidence rates of cardiovascular and renal events among patients treated with/without empagliflozin were derived from the EMPA-REG-OUTCOME trial. All cost estimates were derived from published literature.

RESULTS: The model included 94,802 patients with T2DM and established cardiovascular disease. Adding empagliflozin to standard of care in these patients would increase drug acquisition costs by €33,960,252 compared with standard of care alone (€60,557,082 vs €26,596,830) but would decrease utilisation of other diabetes drugs, and cardiovascular and renal management costs by €43,943,428 (€134,090,549 vs €178,033,977). Addition of empagliflozin to standard of care would, therefore, save €9,983,176/year.

CONCLUSIONS: In a long-term modelling approach, adding empagliflozin to standard of care would reduce the annual cost of managing patients in the Netherlands with T2DM and established cardiovascular disease by almost €10 million. This budget saving is driven by reduction in cardiovascular and renal events.