OBJECTIVES: Canagliflozin is a sodium glucose co-transporter 2 inhibitor which reduces HbA1c, blood pressure, and weight loss, and has a low intrinsic risk for hypoglycaemia. In the CANagliflozin cardioVascular Assessment Study (CANVAS), canagliflozin significantly reduced the risk of major atherosclerotic cardiovascular events (MACE) by 14% over 3.6 years in 10,142 T2DM patients with high risk of developing or with established CVD versus placebo. There were also numerical differences in favour of canagliflozin for non-fatal myocardial infarction (MI) and stroke, CV death, and hospitalisation for heart failure (HHF). Given this, we used CANVAS data to estimate CV events and deaths avoided and associated cost offsets for canagliflozin vs. standard of care (SoC) from the perspective of the NHS in England.

METHODS: It was assumed that 50.5% of the T2DM population in England met the inclusion/exclusion criteria of CANVAS based on a US database analysis. The rates observed in CANVAS were applied to the eligible population to estimate the CVD events avoided for canagliflozin over SoC over 5 years. Unit costs, obtained from the literature (primarily UKPDS), were multiplied by the number of events to estimate cost offsets for canagliflozin over SoC. The impact of including drug costs and adverse events as part of the analysis was tested in the sensitivity analysis.

RESULTS: It was estimated that the use of canagliflozin could avoid 42,000 MACE events, 16,000 CV deaths and 24,000 all-cause deaths over 5 years. Reductions of 17,000 MIs, 8,000 strokes, and 28,000 HHFs were associated with cost offsets of £360 million (£130, £62 and £168 million, respectively) over this period.

CONCLUSIONS: Using canagliflozin in T2DM patients with high risk of or with established CVD can improve health in England by controlling HbA1c and reducing CV events, while allowing substantial near-term cost offsets.