OBJECTIVES: Both empagliflozin and canagliflozin are SGLT-2 inhibitors that have been shown independently to be effective in the reduction of cardiovascular (CV) and renal events when compared to placebo. However, only empagliflozin has been related to a decreased risk of CV death. The objective of this study was to assess the cost-effectiveness of empagliflozin compared to canagliflozin as treatment in patients with type-2 diabetes mellitus (T2DM) and established cardiovascular disease within the Spanish National Health Service (NHS).

METHODS: Economic evaluation study based upon estimated parameters from an indirect treatment comparison (ITC) of the EMPA-REG-OUTCOME™ trial and the CANVAS Program with the Bucher method. A Markov model was created to estimate the incremental cost-effectiveness ratio (ICER) of empagliflozin vs. canagliflozin in the Spanish NHS. The perspective was provider with direct costs only and both 3% discount rate for costs and utilities were used. The time horizon considered was the patient’s lifetime. One-way and probabilistic sensitivity analyses (PSA) were performed to assess the results robustness.

RESULTS: In this economic model, empagliflozin had extended economic dominance over canagliflozin. The base-case ICER was -916€/QALY 95% CI (-1,290, -570) over the patient’s lifetime. Both drug and event related costs were lower for empagliflozin patients. One-way sensitivity analysis show that results were most sensitive to an increase in the drug cost of empagliflozin, clinical outcomes cost, the time horizon and the perspective of analysis. PSA show that empagliflozin has a probability of 100% of being cost-saving over canagliflozin at a 25,000€/QALY willingness-to-pay (WTP) threshold.

CONCLUSIONS: There are two main limitations of this study, first, differences in the study design between the three trials are present, and, second, neither trial was powered to detect statistical differences for the exploratory outcomes considered. However, extended economic dominance suggests empagliflozin to be considered as a cost-effective alternative to canagliflozin at any WTP threshold.