Cost-Effectiveness of SGLT2is Versus DPP4is Among Type 2 Diabetes Patients with and Without Established Cardiovascular Disease: A Model-Based Simulation Analysis Using 10-Year Real-World Data and Systematic Review

Abstract Background: We conducted a model-based economic analysis of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) in type 2 diabetes (T2D) patients with and without established cardiovascular disease (CVD) using 10-year real-world data. Methods: A Markov model was utilized to estimate healthcare costs and quality-adjusted life-years (QALYs) over a 10-year simulation time horizon from a healthcare sector perspective, with both costs and QALYs discounted at 3% annually. Model inputs were derived from analyses of Taiwan’s National Health Insurance Research Database or published studies of Taiwanese populations. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). Incorporated with our study findings, a structured systematic review was conducted to synthesize updated evidence on the cost-effectiveness of SGLT2is versus DPP4is. Results: Over 10 years, use of SGLT2is versus DPP4is yielded ICERs of $3,244 and $4,186 per QALY gained for T2D patients with and without established CVD, respectively. Results were robust across a series of sensitivity and scenario analyses, showing ICERs between $-1,074 (cost-saving) and $8,467 per QALY gained for T2D patients with established CVD and between $369 and $37,122 per QALY gained for T2D patients without established CVD. A systematic review revealed a cost-effective or even cost-saving profile of using SGLT2is for T2D treatment. Conclusions: Use of SGLT2is versus DPP4is was highly cost-effective for T2D patients regardless of patients’ CVD history in real-world clinical practice. Our results extend current evidence by demonstrating SGLT2is as an economically rational alternative over DPP4is for T2D treatment in routine care. Future research is warranted to explore heterogenous economic benefits of SGLT2is given diverse patient characteristics in clinical settings.

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PDB66 - INSULIN GAP IN TYPE 2 DIABETES: IS IT COST EFFECTIVE TO INTENSIFY TREATMENT? EVIDENCE FROM PORTUGAL USING REAL WORLD DATA

Value in Health ◽

10.1016/j.jval.2018.09.771 ◽

2018 ◽

Vol 21 ◽

pp. S129

Author(s):

F. Fiorentino ◽

R. Ascenção ◽

J. Costa ◽

M. Gouveia ◽

M. Borges

Keyword(s):

Type 2 Diabetes ◽

Real World ◽

Cost Effective ◽

Real World Data ◽

World Data

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PDB23 SWITCHING TO INSULIN DEGLUDEC IS A COST-SAVING THERAPY FOR PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES IN THE SWEDISH SETTING BASED ON REAL WORLD DATA

Value in Health ◽

10.1016/j.jval.2019.09.905 ◽

2019 ◽

Vol 22 ◽

pp. S575-S576

Author(s):

J. Jendle ◽

M. Thunander ◽

B. Ekman ◽

S. Sjöberg ◽

Å. Ericsson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Saving ◽

Real World ◽

Insulin Degludec ◽

Real World Data ◽

World Data

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Cost-effectiveness of GLP-1 receptor agonists versus insulin for the treatment of type 2 diabetes: a real-world study and systematic review

Cardiovascular Diabetology ◽

10.1186/s12933-020-01211-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Chen-Yi Yang ◽

Ying-Ren Chen ◽

Huang-Tz Ou ◽

Shihchen Kuo

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Cost Effectiveness ◽

Real World ◽

Cost Effective ◽

Injection Therapy ◽

Healthcare Sector ◽

All Cause Mortality ◽

Diabetes Patients

Abstract Background To conduct a real-word-study-based cost-effectiveness analysis of a GLP-1 receptor agonist (GLP-1RA) versus insulin among type 2 diabetes patients requiring intensified injection therapy and a systematic review of cost-effectiveness studies of GLP-1RAs versus insulin. Methods Individual-level analyses incorporating real-world effectiveness and cost data were conducted for a cohort of 1022 propensity-score-matched pairs of GLP-1RA and insulin users from Taiwan’s National Health Insurance Research Database, 2007–2016. Study outcomes included the number needed to treat (NNT) to prevent one case of clinical events, healthcare costs, and cost per case of event prevented. Costs were in 2019 US dollars. Analyses were performed from a third-party payer and healthcare sector perspectives. Structured systematic review procedures were conducted to synthesize updated evidence on the cost-effectiveness of GLP-1RAs versus insulin. Results Over a mean follow-up of 2.3 years, the NNT using a GLP-1RA versus insulin to prevent one case of all-cause mortality and hospitalized hypoglycemia was 57 and 30, respectively. Using GLP-1RAs instead of insulin cost US$54,851 and US$29,115 per case of all-cause mortality and hospitalized hypoglycemia prevented, respectively, from the payer perspective, and saved US$19,391 and US$10,293, respectively, from the healthcare sector perspective. Sensitivity analyses showed that the probability of using GLP-1RAs versus insulin being cost-effective for preventing one case of all-cause mortality or hospitalized hypoglycemia ranged from 60 to 100%. The systematic review revealed a cost-effective profile of using GLP-1RAs versus insulin. Conclusions Using GLP-1RAs versus insulin for type 2 diabetes patients requiring intensified injection therapy in clinical practice is cost-effective.

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Real world data of Type 2 Diabetes Mellitus (T2DM) obese patients using another GLP1 receptor agonist (GLP1–RA) and switching to Semaglutide in Spain

Endocrine Abstracts ◽

10.1530/endoabs.70.ep197 ◽

2020 ◽

Author(s):

Jersy Cardenas ◽

Gomez Nancy Sanchez ◽

Sierra Poyatos Roberto Miguel ◽

Luca Bogdana Luiza ◽

Mostoles Naiara Modroño ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Real World ◽

Receptor Agonist ◽

Obese Patients ◽

Real World Data ◽

World Data

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126-LB: Glycemic Outcomes for People with Type 1 and Type 2 Diabetes Using Control-IQ Technology: Real-World Data from Early Adopters

Diabetes ◽

10.2337/db20-126-lb ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 126-LB ◽

Cited By ~ 1

Author(s):

STEPHANIE HABIF ◽

ALEXANDRA CONSTANTIN ◽

LARS MUELLER ◽

HARSIMRAN SINGH

Keyword(s):

Type 2 Diabetes ◽

Real World ◽

Real World Data ◽

Early Adopters ◽

World Data ◽

Glycemic Outcomes

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Abstract W P273: The Cost-Effectiveness of Telestroke Varies by Implementation Cost and Stroke Severity: Real World Data From a Pacific Northwest Network

Stroke ◽

10.1161/str.46.suppl_1.wp273 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Elizabeth Baraban ◽

Richard Nelson ◽

Alexandra Lesko ◽

Jennifer Majersik ◽

Archit Bhatt ◽

...

Keyword(s):

Cost Effectiveness ◽

Pacific Northwest ◽

Real World ◽

Cost Effective ◽

Stroke Severity ◽

Real World Data ◽

World Data ◽

Life Years ◽

Implementation Costs ◽

The Cost

Objective: An obstacle for community hospitals in joining a telestroke network is often the cost of implementation. Yet, previous analyses examining the cost and cost-effectiveness have only used estimates from the literature. Using real-world data from a Pacific Northwest telestroke network, we examined the cost-effectiveness of telestroke for spokes by level of financial responsibility for these costs and how this changes with patient stroke severity. Methods: We constructed a decision analytic model and parameterized it using patient-level clinical and financial data from the Providence Telestroke Network (PTN) pre and post telestroke implementation. Data included patients presenting at 17 spokes within 4.5 hours of symptom onset. Probability inputs included observed IV-tPA treatment rates, transfer status and hospital costs and reimbursements. Effectiveness, measured as quality-adjusted life years (QALYs), and cost per patient were used to calculate incremental cost effectiveness ratios (ICERs). ICER’s of <$50,000-$120,000/QALY are considered cost-effective. Outcomes were generated overall and separately by admit NIHSS, defined as low (0-10), medium (11-20) and high (>20) and percentage of implementation costs paid by spokes (0%, 50%, 100%). Results: Data for 594 patients, 105 pre- and 489 post-implementation, were included. See Table 1. Conclusions: Our results support previous theoretic models showing good value, overall. However, costs and ICERs varied by stroke severity, with telestroke being most cost-effective for severe strokes. Telestroke was least cost effective if spokes paid for half or more of implementation costs.

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Heart failure among people with Type 2 diabetes mellitus: real‐world data of 289 954 people from a diabetes database

Diabetic Medicine ◽

10.1111/dme.13915 ◽

2019 ◽

Vol 37 (8) ◽

pp. 1291-1298

Author(s):

D. Stoyanova ◽

B. Stratmann ◽

A. Schwandt ◽

N. Heise ◽

S. Mühldorfer ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Real World ◽

Real World Data ◽

World Data

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Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz169 ◽

2019 ◽

Vol 14 (4) ◽

pp. 490-500 ◽

Cited By ~ 4

Author(s):

Nadia Pillai ◽

Judith E Lupatsch ◽

Mark Dusheiko ◽

Matthias Schwenkglenks ◽

Michel Maillard ◽

...

Keyword(s):

Crohn’S Disease ◽

Cost Effectiveness ◽

Crohn's Disease ◽

Health System ◽

Real World ◽

Transition Probabilities ◽

Cost Effective ◽

Real World Data ◽

World Data ◽

The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

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