Health expenditure and health services utilization comparison of patients with type 2 diabetes on sodium–glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: evidence from 2015 to 2016 medical expenditure panel survey

Abstract

Abstract Objectives Primary objective of this study was to compare the overall health expenditures of patients with type 2 diabetes on sodium–glucose cotransporter-2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors. Methods Two cohorts of type 2 diabetes patients receiving either SGLT2 inhibitor with metformin or DPP4 inhibitor with metformin were identified from 2015 to 2016 Medical Expenditure Panel Survey (MEPS) data. Propensity score matching was used to balance cohorts based on socio-economic status, insulin utilization status, and the Charlson comorbidity score. Patients in SGLT2 inhibitor cohort were matched with patients in DPP4 inhibitor cohort using 1 : 2 ratio on the logit of propensity score using caliper width of 0.1 of the standard deviation of the logit of the propensity score. Expenditure variables were analysed using a generalized linear model with log link function and gamma distribution and adjusted for socio-economic variables. Unadjusted means were obtained using bootstrap. Results After propensity score matching, 240 patients were left in the sample with 80 patients in SGLT2 inhibitor cohort and 160 patients in DPP4 inhibitor cohort. Unadjusted average annual total health expenditure was significantly higher in the SGLT2 inhibitor cohort versus DPP4 inhibitor cohort ($17,325 versus $15,702; P value <0.0001). After adjusting for socio-economic factors, overall health expenditure (β = −0.3516; P = 0.0038) was significantly lower in DPP4 inhibitor cohort compared to SGLT2 inhibitor. Conclusion SGLT2 inhibitors were associated with significantly higher overall and prescription expenditures compared to DPP4 inhibitors during the study period evaluated. Future studies need to utilize administrative claims data to assess current comparativeness effectiveness trends.