Evaluating the costs of glycemic response with canagliflozin versus dapagliflozin and empagliflozin as add-on to metformin in patients with type 2 diabetes mellitus in the United Arab Emirates

Abstract

Objective: This study evaluates the cost of achieving glycemic control with three sodium glucose co-transporter 2 (SGLT2) inhibitors, canagliflozin, dapagliflozin, and empagliflozin, in patients with type 2 diabetes mellitus (T2DM) from the payer perspective in the United Arab Emirates (UAE).

Methods: A systematic literature review identified randomized controlled trials of antihyperglycemic agents as add-on to metformin in patients with T2DM of 26 ± 4 weeks in duration, published by 10 September 2014. A Bayesian network-meta analysis (NMA) compared HbA1c changes with canagliflozin 100 and 300 mg versus dapagliflozin 10 mg and empagliflozin 10 and 25 mg. The cost associated with a 1% placebo-adjusted HbA1c reduction with each SGLT2 inhibitor as add-on to metformin was calculated based on NMA results and UAE drug costs.

Results: In the NMA, canagliflozin 100 and 300 mg were associated with HbA1c reductions (−0.67% and −0.79%) compared with dapagliflozin 10 mg (−0.41%) and empagliflozin 10 and 25 mg (−0.57% and −0.64%). Probabilities of canagliflozin 100 mg performing better were 79%, 60%, and 53% versus dapagliflozin 10 mg and empagliflozin 10 and 25 mg, respectively; probabilities for canagliflozin 300 mg performing better were 88%, 72%, and 65%, respectively. The cost per 1%-point reduction in HbA1c was projected to be lower with canagliflozin 100 and 300 mg ($448 and $422) compared with dapagliflozin 10 mg ($785) and empagliflozin 10 and 25 mg ($527 and $563).

Conclusions: Canagliflozin may provide a greater glycemic response at a lower effective cost than dapagliflozin or empagliflozin for patients with T2DM inadequately controlled with metformin from the payer perspective in the UAE.

Keywords:

• Canagliflozin
• Comparative effectiveness
• Network meta-analysis
• Sodium glucose co-transporter 2 (SGLT2) inhibitors
• Type 2 diabetes mellitus
• United Arab Emirates

Transparency

Declaration of funding

This work was funded by Janssen Pharmaceutica NV.

Author contributions: A.S. and V.T. contributed to the design of the study and the analysis and interpretation of data; they also drafted, reviewed, and approved the manuscript. A.T.B., A.C.E.K., and A.K. contributed to the analysis and interpretation of the data; they also drafted, reviewed, and approved the manuscript.

Declaration of financial or other relationships

A.S., A.T.B., A.C.E.K., and A.K. have disclosed that they are full-time employees of Janssen-Cilag Ltd. V.T. has disclosed that, at the time of the analysis, she was a full-time employee of Amaris, which has provided consulting services for Janssen Pharmaceutica NV.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing support was provided by Felicia Gray, PhD, of MedErgy, and was funded by Janssen Pharmaceutica NV. Canagliflozin has been developed by Janssen Research & Development LLC, in collaboration with Mitsubishi Tanabe Pharma Corporation.