The health and budget impact of sodium-glucose co-transporter-2 inhibitors (SGLT2is) in The Netherlands

Figures & data

Figure 1. Flow diagram for the estimation of the study populations.

Table 1. Costs and disutilities per event type.

Health outcomes	Costs – €, 2020	Costs in subsequent years – €, 2020	Event-related disutilities
Events
HF-related hospitalization	11,166	1,017	0.050
CV mortality	3,775*	–	0.719
MI	5,543	1,094	0.047
Stroke	5,882	2,098	0.060
First event of kidney-related outcomes	25,648	21,577	0.038
Adverse events
Amputations	17,328	–	0.095
Fractures	3,176	–	0.068
Diabetic ketoacidosis	1,657*	–	0.012

References in brackets, *costs were published in pounds and adjusted to euros using a conversion rate of 1.11. Abbreviations. HF, heart failure; CV, cardiovascular; MI, myocardial infarction.

Table 2. The potential total number of clinical events averted following the introduction of the new DM guideline.

Clinical event	1 year	3 years	5 years	10 years
MACE
Previous situation	10,706	31,335	50,961	95,957
New situation	9,234	27,139	44,320	84,288
Net difference	1,472	4,195	6,641	11,668
HF-related hospitalization
Previous situation	5,346	15,594	25,277	47,219
New situation	3,621	10,616	17,292	32,688
Net difference	1,725	4,978	7,985	14,531
CV mortality
Previous situation	5,962	17,399	28,217	52,768
New situation	4,743	13,907	22,658	42,847
Net difference	1,219	3,492	5,559	9,921
Non-fatal MI
Previous situation	6,266	18,313	29,742	55,821
New situation	5,289	15,528	25,330	48,047
Net difference	977	2,785	4,412	7,774
Non-fatal stroke
Previous situation	3,742	10,926	17,728	33,200
New situation	3,507	10,291	16,777	31,782
Net difference	235	635	951	1,417
First event of kidney-related outcomes
Previous situation	5,569	16,214	26,237	48,807
New situation	3,428	10,028	16,302	30,663
Net difference	2,141	6,186	9,935	18,144
Mortality
Previous situation	8,955	26,135	42,389	79,300
New situation	7,450	21,844	35,591	67,318
Net difference	1,505	4,291	6,798	11,982
Amputations
Previous situation	1,367	3,991	6,477	12,135
New situation	1,721	5,049	8,231	15,587
Net difference	−354	−1,058	−1,753	−3,452
Fractures
Previous situation	4,251	12,414	20,147	37,744
New situation	4,588	13,461	21,943	41,555
Net difference	−338	−1,047	−1,797	−3,811
Diabetic ketoacidosis
Previous situation	119	347	563	1,055
New situation	261	766	1,249	2,366
Net difference	−142	−420	−686	−1,311

Abbreviations. DM, diabetes mellitus; MACE, major adverse cardiovascular events; HF, heart failure; CV, cardiovascular; MI, myocardial infarction. Negative values indicate additional clinical events gained in the new situation.

Figure 2. Tornado diagram with the results of the one-way sensitivity analysis.

Table 3. Budget impact results for different time horizons.

Budget impact	1 year	3 years	5 years	10 years
Previous setting	€319,147,022	€1,045,537,499	€1,381,346,797	€3,926,161,126
New setting	€411,096,738	€1,285,886,440	€2,194,627,552	€4,519,588,299
Net budget impact	€91,949,716	€240,348,941	€351,855,124	€593,427,173
Patient-day costs	€0.75	€0.66	€0.57	€0.46

Table 4. Budget impact results based on assuming different SGLT2i market share scenarios.

Assumed share of SGLT2i utilization (%)	Budget impact after 5 years	Per patient-day costs
25	€79,267,454	€1.18
50	€170,634,767	€0.98
75	€261,497,931	€0.78
100	€351,855,124	€0.57

Abbreviation. SGLT2i, sodium-glucose co-transporter-2 inhibitor.