Pharmacoeconomic evaluation of sodium-glucose transporter-2 (SGLT2) inhibitors for the treatment of type 2 diabetes

ABSTRACT

Introduction: Clinicians have many safe and effective options for the treatment of type 2 diabetes that can improve glycemic control and effect other cardio-metabolic parameters. Sodium-glucose transporter-2 inhibitors (SGLT-2) are the most recent class of therapies, have a novel mechanism of action, and provide good glycemic efficacy and a favorable cardiovascular risk profile. Cost-effectiveness data can play an important role in assessing the benefits of this class of therapy in anti-diabetes treatment regimens.

Areas covered: This review summarizes all the available evidence regarding the cost-effectiveness of SGLT-2 inhibitors. For the purposes of this article, the authors have performed a systematic review of pharmacoeconomic analyses through a non-restricted literature until June 2018.

Expert opinion: The available analyses demonstrate that SGLT-2 inhibitors are a more cost-effective option compared to other oral anti-diabetes therapies and insulin in the treatment of individuals with uncontrolled type 2 diabetes. Future studies should examine populations with renal and liver disease and expand data of some SGLT-2 inhibitors to patients at high cardiovascular risk and hard endpoint data.

KEYWORDS:

• canagliflozin
• cost-effectiveness
• dapagliflozin
• empagliflozin
• type 2 diabetes

Article highlights

• Diabetes mellitus and its complications represents a significant cost burden in the United States and around the world.

• SGLT2 inhibitors incur high pharmacy-related expenses but are recommended as add-on therapy due to their favorable cardiovascular risk profile and weight loss potential.

• In individuals with uncontrolled T2DM on MET monotherapy, addition of EMPA, CANA or DAPA was consistently found to be more cost-effective compared to SU, DPP-4i, TZDs, or insulin.

• Cost-effectiveness was generally thought to be reflective of reduction in HbA1c and in some cases, improvement in other favorable cardio-metabolic parameters, however, these were secondary endpoint evaluations.

• Further data using hard endpoints such as mortality, MI or hospitalization for heart failure will strengthen future data.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

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

Additional information

Funding

This manuscript has not been funded.