Abstract 232: Initiating Empagliflozin vs. Glucagon-like Peptide 1 Receptor Agonists is Associated With Lower Healthcare Cost of Care Among Patients With Type 2 Diabetes and Cardiovascular Disease

Abstract

Background: The 2019 ADA’s Standards of Medical Care in Diabetes recommend use of SGLT-2 inhibitor (SGLT-2i) or GLP-1 receptor agonist (GLP-1RA) as one of the six drug classes after metformin (MET) in type 2 diabetes (T2D) patients, and is recommended as the treatment of choice among patients with cardiovascular disease (CVD; empagliflozin [EMPA] and liraglutide showing stronger evidence). CVD benefits of empagliflozin and GLP-1 RAs have been demonstrated in clinical trials; however, the impact on all-cause (AC) healthcare costs has not been studied. Methods: This retrospective cohort study utilized an US based, commercial claims database (IQVIA Pharmetrics Plus) to identify patients with T2D and CVD who initiated empagliflozin or a GLP-1 RA between 08/01/2014 - 12/31/2016. First prescription date (index date) for empagliflozin or a GLP-1 RA was used to classify patients into study cohorts. During a post-index period of up to 1 year, AC costs were computed on a per patient per month (PPPM) basis; and evaluated using generalized linear models that controlled for pre-index covariates. A sub-analysis comparing AC costs among patients who initiated second-line treatment with empagliflozin or a GLP-1 RA after metformin monotherapy, was also conducted. Results: As compared to the GLP-1 RA cohort (N = 1376), patients in the empagliflozin cohort (N= 441) were more likely to be males, had a lower Charlson comorbidity score, higher rates of dyslipidemia, and lower rates of obesity in the 1-year pre-index period; all other measured pre-index characteristics were similar. After covariate adjustment, compared to GLP-1 RA cohort, the empagliflozin cohort had lower total AC PPPM (($1,766 vs. $2,096; difference (Δ) = $330, p<0.001 ), medical (Δ = $97, p=0.28 ), and pharmacy (Δ = $228, p<0.001 ) costs. In patients who initiated 2 nd line empagliflozin or GLP-1 RA treatment, the empagliflozin cohort (N = 160) had lower total AC PPPM (($1,432 vs. $1,969; Δ = $536, p<0.001 ), medical (Δ = $275, p=0.02 ), and pharmacy (Δ = $225, p=0.12 ) costs, compared to the GLP-1 RA cohort (N = 477). Conclusions: In patients diagnosed with T2D & CVD, initiating empagliflozin compared to GLP-1 RA was associated with lower all-cause healthcare costs. Together with ADA guidelines, these findings can provide critical insights for health care decision makers for reducing the clinical and economic burden for patients with T2D & CVD.