Abstract
We aimed to compare the (1) clinical outcomes including composite cardiovascular outcomes, cardiovascular death, and all-cause death, and (2) healthcare costs of using liraglutide and basal insulin as an initial treatment for patients with type 2 diabetes mellitus (T2DM) and high cardiovascular diseases (CVD) risk. This is a retrospective cohort study using Taiwan’s Health and Welfare Database. A total of 1057 patients treated with liraglutide were identified and matched with 4600 patients treated with basal insulin. The liraglutide group had a lower risk of a composite CVD outcome (hazard ratio (HR) 0.65; 95% confidence interval (CI) 0.50–0.85; p < 0.01), all-cause mortality (HR 0.40; 95% CI 0.28–0.59; p < 0.0001), and nonfatal stroke (HR 0.54; 95% CI 0.34–0.87; p = 0.01). Compared to the basal insulin group, the liraglutide group had lower median per-patient-per-month (PPPM) inpatient, emergency room (ER), and total medical costs, but higher median PPPM outpatient, total pharmacy, and total costs (all p < 0.0001). In conclusion, compared to basal insulin, liraglutide was found to be associated with reduced risk of a composite CVD outcome, nonfatal stroke, and all-cause mortality among high CVD risk patients with T2DM. In addition, liraglutide users had lower inpatient, ER, and total medical costs, but they had higher outpatient and total pharmacy costs.
Highlights
Diabetes mellitus is a complex metabolic disorder that affects more than 400 million people in the w orld[1,2], with over 90% of those patients diagnosed with type 2 diabetes mellitus (T2DM)[3]
In Taiwan, all antidiabetic medicines with cardiovascular benefits are covered by the National Health Insurance (NHI) except semaglutide, and since liraglutide was the first one to be covered by the NHI, it provides a longer period for observing outcomes
In the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, liraglutide was associated with lower risks of a composite cardiovascular diseases (CVD) outcome, cardiovascular mortality, and all-cause mortality in patients with T2DM and high CVD risk[15], whereas basal insulin showed a neutral effect on CVD16,17
Summary
Diabetes mellitus is a complex metabolic disorder that affects more than 400 million people in the w orld[1,2], with over 90% of those patients diagnosed with type 2 diabetes mellitus (T2DM)[3]. According to the American Diabetes Association guidelines[14] for patients with T2DM and high CVD risk, glucagon like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter 2 inhibitors that have cardiovascular benefits are suggested as second-line treatments. In the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, liraglutide was associated with lower risks of a composite CVD outcome, cardiovascular mortality, and all-cause mortality in patients with T2DM and high CVD risk[15], whereas basal insulin showed a neutral effect on CVD16,17. In a study of the healthcare costs of liraglutide, Shah et al demonstrated that liraglutide combined with standard treatment was cost-effective over a lifetime horizon for T2DM patients with high CVD risk compared to standard care as a result of a reduction of event-related costs and an increase in both quality-adjusted lifeyears and life-years[18]. We aimed to compare liraglutide and basal insulin on (1) clinical outcomes, including a composite cardiovascular outcome, cardiovascular death, and all-cause death, and (2) healthcare costs from the perspective of Taiwan’s NHI
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