CELESTIA: Cost-Effectiveness Analysis of Empagliflozin Versus Sitagliptin in Patients with Type 2 Diabetes in Greece

Abstract

Purpose

Globally, the prevalence of diabetes is on the rise, with the number of affected individuals predicted to cross 700 million by 2045. In Greece, in 2015, almost 700,000 people received prescribed medication for type 2 diabetes. The CELESTIA study aims to assess the cost-effectiveness of empagliflozin compared to branded sitagliptin in type 2 diabetes patients both with and without established cardiovascular disease in Greece from a third payer perspective.

Methods

The IQVIA Core Diabetes Model was used and analyses were conducted from the Greek healthcare payer perspective. Patients received either empagliflozin or sitagliptin until HbA1c threshold of 8.5% (69 mmol/mol) was exceeded. Subsequently, patients were assumed to intensify to insulin therapy. Baseline cohort characteristics and treatment effects were derived from clinical trial data. Literature data were used for input (utilities, treatment costs and costs of diabetes-related complications costs). A lifetime time horizon (50 years) was applied, and costs and benefits were discounted at an annual rate of 3.5%.

Results

Over a lifetime horizon, for empagliflozin, the estimated ICER was of €6,587 and €966 per quality-adjusted life years gained versus sitagliptin, in patients without established cardiovascular disease and in patients with established cardiovascular disease, respectively. Probabilistic sensitivity analysis confirmed the robustness of the analysis.

Conclusion

The analysis demonstrated that for type 2 diabetes patients, empagliflozin is a cost-effective treatment option versus branded sitagliptin in Greece.

Keywords:

• cost-effectiveness
• empagliflozin
• Greece
• IQVIA core diabetes model
• sitagliptin
• type 2 diabetes

Data Sharing Statement

All data generated or analyzed during this study are included in this published article/as Supplementary Information Files.

Ethics Approval

This article is based on the IQVIA CDM, which was used to simulate the long-term clinical and economic results of empagliflozin and sitagliptin based on existing literature findings and completed clinical trials. Moreover, it does not involve any studies on human participants and animals directly performed by any of the authors.

Code Availability

Access to the IQVIA CDM is available upon payment. For more information visit http://www.core-diabetes.com/.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Ghetti G and Pradelli L are employees of AdRes, which has received project funding by Boehringer Ingelheim. Ghetti G reports grants from Amgen, AstraZeneca, Biogen, Fresenius Kabi, Janssen-Cilag, Novartis Gene Therapies, and Roche, outside the submitted work. Pradelli L reports grants from Amgen S.r.l, AstraZeneca S.p.A., Brahms GmbH, Biogen Italia S.R.L., Gilead Sciences S.R.L., Ipsen S.p.A., Janssen-Cilag S.p.A., Novartis Farma S.p.A., Novartis Gene Therapy EU Limited, Roche S.p.A., Sanofi S.R.L., and UCB Pharma S.p.A.; grants and personal fees from Fresenius Kabi GmbH, outside the submitted work. Papageorgiou G and Karpouzos G are employees of Boehringer Ingelheim Hellas, Athens, Greece. Arikan Y is an employee of Boehringer Ingelheim, Amsterdam, The Netherlands. The authors report no other conflicts of interest in this work.

Additional information

Funding

This analysis and manuscript were sponsored and funded by Boehringer Ingelheim that sponsored also the open access fee. Employees were involved in the study design and data analysis, and in the writing of this manuscript.