PDB24 - The Cost of Glycaemic Target Achievement with Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors in Patients with Type 2 Diabetes Mellitus (T2DM) Inadequately Controlled on Metformin and Sulphonylurea (MET+SU) in the UK

Abstract

MET+SU is the commonest dual oral glucose-lowering therapy in the UK; however, many patients on MET+SU fail to achieve the HbA1c goal of <7% advocated for most patients. This analysis compared the costs of achieving HbA1c<7% with currently licensed SGLT2 inhibitors in the UK (canagliflozin, dapagliflozin, empagliflozin) added to MET+SU. Relative effects between SGLT2 inhibitors for the proportion of patients achieving HbA1c<7% were estimated via Bayesian network meta-analysis, conducted in line with NICE guidelines and based on a systematic literature review of add-on to MET+SU trials at 26±4 weeks. Odds ratios (ORs) for CANA 300mg versus EMPA 25mg and CANA 100mg versus DAPA 10mg and EMPA 10mg were estimated. Based on the attainment of HbA1c<7% in clinical trials with each SGLT2 inhibitor, a number needed to treat (NNT) analysis was performed. Average cost per patient treated to HbA1c<7% was calculated based on the current UK price (£1.31/day each). Patients treated with CANA 300mg had higher odds of reaching HbA1c<7% versus EMPA 25mg (OR of 1.71 [P=93%]). ORs for CANA 100mg versus DAPA 10mg and EMPA 10mg were 1.12 (P=60%) and 1.26 (P=73%). The proportions of patients achieving HbA1c<7.0% were 41% and 27% with CANA 300 and 100mg, 25% with DAPA 10mg, and 28% and 23% with EMPA 25 and 10mg. Based on these proportions, the average cost per patient to achieve HbA1c<7% was £880.79, £951.34, and £1,034.07 with CANA 100mg, DAPA 10mg, and EMPA 10mg; the average cost per patient was £580.03 with CANA 300mg and £849.41 with EMPA 25mg. This analysis suggests that for achieving HbA1c<7%, CANA 300mg provides the best value-for-money among medications compared in this analysis and use of CANA 100mg at SGLT2 initiation ensures the lowest possible cost in patients with suboptimal control on MET+SU for whom SGLT2 inhibitor treatment is suitable.