Aims

To estimate the cost-effectiveness of sequential use of the sodium-glucose co-transporter 2 inhibitor empagliflozin and glucagon-like peptide-1 receptor agonist liraglutide after metformin in patients with type 2 diabetes (T2D) from the United States (US) payer perspective.

Materials and Methods

An economic simulation model with a lifetime horizon was developed to estimate T2D-related complications (including CV death, myocardial infarction, stroke, and renal outcomes) using EMPA-REG OUTCOME data or United Kingdom Prospective Diabetes Study risk equations, in patients with or without a history of cardiovascular disease (CVD), respectively. Evidence synthesis methods were used to provide effectiveness inputs for empagliflozin and liraglutide. Population characteristics, adverse event rates, treatment escalation, costs ($2019) and utilities (both discounted 3%/year) were taken from US sources.

Results

Compared with second-line liraglutide in the overall T2D population, second-line empagliflozin was dominant as it was associated with lower total lifetime cost ($11,244/patient less) and resulted in a quality-adjusted life-year (QALY) gain (0.32/patient). Second-line empagliflozin was associated with reductions in CV death (by 5%) and lower cumulative complication rates in patients with CVD (by 2%), relative to second-line liraglutide. These findings were consistent among patients with comorbid CVD, with gains in incremental QALYs (0.43/patient) and lower lifetime cost (by $10,175/patient) relative to second-line liraglutide. Scenario analyses consistently showed dominance for second-line empagliflozin.

Conclusion

For patients with T2D, use of second-line empagliflozin combined with metformin was a dominant strategy for US payers, associated with extended survival, improved QALYs, and lower costs compared with second-line liraglutide.

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