PDB39 Assessing the IMPACT of New ANTI Diabetics Drugs: A Dynamic Microsimulation Approach

Abstract

Assess the impact of SGLT-2i and DPP-4i type drugs on mortality and cardiovascular diseases. In this study a cohort of 63,812 diabetic Italians in 2016, drawn from the Health Search database of general practitioners, was studied to assess the impact of a greater diffusion of new anti-diabetes drugs (SGLT-2i or DPP-4i), in terms of mortality, incidence of cardiovascular diseases and costs, using the dynamic Italian micro-simulation model Future Italian Model.The use of modern dynamic micro-simulation techniques allowed us to model the individual transitions to cardiovascular diseases (angina, heart attack, stroke, ischemic heart disease, heart failure and hypertension), death and drug therapies. Furthermore, we were able to construct policy relevant “what-if'' scenarios about the usage of the new anti-diabetes drugs, building on the effects reported by the relevant literature. Preliminary results indicate that an increase in the prevalence of Dual therapy with SGLT-2i or DPP-4i would have positive effects in terms of reducing the prevalence of cardiovascular events, the number of deaths and the total costs associated with diabetes. Being a cohort of elderly patients (the average age is 71), the greatest benefits in terms of reduced mortality and increased life expectancy at 65 are concentrated between 2017 and 2020, when up to 3 months of life expectancy at 65 could be gained. An increase in the share of Dual therapy with SGLT2 or Dpp-4 up to 80% of all dual therapies, albeit associated with higher pharmaceutical expenditure, could induce up to 100,000 fewer deaths by 2035 compared to the baseline scenario and it would lead to savings of almost € 4 billion.