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Cost-effectiveness of empagliflozin in patients with type 2 diabetes and established cardiovascular disease in China.
- Source :
-
Cost Effectiveness & Resource Allocation . 8/4/2021, Vol. 19 Issue 1, p1-11. 11p. - Publication Year :
- 2021
-
Abstract
- Background: In several cardiovascular outcome trials (CVOTs), empagliflozin (SGLT-2 inhibitor), sitagliptin (DPP-4 inhibitor) and liraglutide (GLP-1 receptor agonist) + standard of care (SoC) were compared to SoC in patients with type 2 diabetes and established cardiovascular disease (CVD). This study assessed the cost-effectiveness (CE) of empagliflozin + SoC in comparison to sitagliptin + SoC and liraglutide + SoC based on the respective CVOT. Methods: The IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the CVOT outcomes. EMPA-REG OUTCOME baseline characteristics and CVOT specific treatment effects on risk factors for cardiovascular disease (HbA1c, BMI, blood pressure, lipids) were applied. Three-year observed cardiovascular events of empagliflozin + SoC versus sitagliptin + SoC and liraglutide + SoC were derived from EMPA-REG OUTCOME and an indirect treatment comparison. Relative risk adjustments to calibrate the CDM were obtained after a trial and error process to match as closely the observed and CDM-predicted outcomes. The drug-specific treatment effects were considered up until HbA1c reached 8.5% and treatment switch occurred. After this switch, the United Kingdom Prospective Diabetes Study 82 risk equations predicted events based on co-existing risk factors and treatment intensification to basal bolus insulin were applied. The analysis was conducted from the perspective of the Chinese healthcare system applying 3% discounting. The time horizon was lifelong. Results: Empagliflozin + SoC provides additional Quality Adjusted Life years (QALY + 0.564) for an incremental cost of 42,497RMB (US$6053) compared to sitagliptin + SoC, resulting in an Incremental Cost Utility Ratio of 75,349RMB (US$10,732), thus below the willingness-to-pay threshold of 212,676RMB, corresponding to three times the Gross Domestic Product in China (2019). Compared to liraglutide + SoC, empagliflozin + SoC use leads to 0.211QALY gained and cost savings of 71,427RMB (US$10,173) and is as such dominant. Scenario and probabilistic sensitivity analyses demonstrated the robustness of the results. Conclusion: Results suggest that empagliflozin + SoC is cost-effective compared to sitagliptin + SoC and liraglutide + SoC at a willingness-to-pay threshold of 212,676RMB ($30,292)/QALY. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CARDIOVASCULAR diseases risk factors
*GLYCOSYLATED hemoglobin
*BLOOD pressure
*RELATIVE medical risk
*EMPAGLIFLOZIN
*CARDIOVASCULAR diseases
*SITAGLIPTIN
*COST control
*TYPE 2 diabetes
*RISK assessment
*COST effectiveness
*GLUCAGON-like peptide-1 agonists
*BODY mass index
*LIPIDS
*QUALITY-adjusted life years
Subjects
Details
- Language :
- English
- ISSN :
- 14787547
- Volume :
- 19
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Cost Effectiveness & Resource Allocation
- Publication Type :
- Academic Journal
- Accession number :
- 151736694
- Full Text :
- https://doi.org/10.1186/s12962-021-00299-z