OBJECTIVES

: Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) are an established, cost-effective treatment option for the management of type 2 diabetes in the UK. Previous estimates of cost-effectiveness were typically driven by avoidance of weight gain and hypoglycaemia in the short term, and diabetes-related vascular events in the longer term. However, short-term observational data from the Comparative Effectiveness of Cardiovascular Outcomes (CVD-REAL) study showed that SGLT-2i were associated with a significantly lower risk of hospitalisation for heart failure (HHF) and all-cause death (ACD) versus other glucose lowering drugs (oGLD). The objective of this study was to quantify the potential additional health economic value of short-term cardiovascular benefits associated with SGLT-2i.

METHODS

: Parametric survival curves were fitted to 730-day Kaplan-Meier data from CVD-REAL and implemented within an Area Under the Curve model framework to model three mutually exclusive health states: Alive without HHF; HHF; Dead. Health state utilities and event costs (UK, 2017) were applied and discounted at 3.5% to estimate the expected within-study quality-adjusted life years (QALYs) and event-related costs associated with SGLT-2i and oGLD.

RESULTS

: Over the 2-year modelled horizon, 6.2 HHF and 11.5 ACD events were predicted per 1,000 patients initiated on SGLT-2i versus 11.1 HHF and 23.9 ACD events per 1000 patients initiated on oGLD. A 9-day mean length-of-stay per HHF avoided led to 43 fewer bed-days per 1,000 patients associated with SGLT-2i versus oGLD. Per 1,000 patients initiated on SGLT-2i, estimated event-related costs and QALYs were £28,199 and 1,534, respectively, versus £50,216 and 1,523 QALYs per 1,000 patients initiated on oGLD.

CONCLUSIONS

: Previous economic evaluations of SGLT-2is may have underestimated short-term cardiovascular benefits. Although the estimates in this study should be interpreted in the context of possible residual confounding, the modelled QALY gains and cost savings associated with the real-world observations of CVD-REAL represent additional possible benefits not previously considered in economic evaluations.