Abstract
Type 2 diabetes mellitus (T2DM) affects 9.7% of Americans, contributing to an annual average medical expenditure of $16,750. Recent data has shown that sodium glucose co-transporter 2 inhibitors (SGLT2i) reduce cardiovascular risk, while the dipeptidyl peptidase-4 inhibitors (DPP4i) have a neutral effect on cardiovascular risk. Our aim was to compare health care expenditure and utilization between individuals prescribed an SGLT2i or DPP4i. Retrospective, cross-sectional data obtained from the 2016 to 2017 Medical Expenditure Panel Survey (MEPS) were utilized for this study. Patients with a diagnosis of T2DM were identified and categorized in two groups based on antidiabetic prescription use: 1) DPP4i inhibitor plus metformin, or 2) SGLT2i plus metformin. The data were adjusted for the complex survey design of MEPS and analyzed using t-tests, chi-square tests, and a generalized linear model with gamma distribution and log-link, with an α = 0.05. Of the 599 eligible individuals, 74.8% (n=448) were taking a DPP4i and 25.2% (n=151) were taking an SGLT2i. Patients taking an SGLT2i compared to a DPP4i were predominately male (65.9% versus 48.7%, p=0.0001), white (84.7% versus 73.9%, p=0.0135), younger (57.7 versus 64.1, p<.0001), and employed (67.5% versus 33.3%, p=<.0001). Mean total health care expenditure differed significantly between groups, with individuals taking an SGLT2i incurring higher overall costs compared to those taking a DPP4i [$19,695 (SD=$4,828) versus $18,023 (SD=$4,254), p=0.0002]. Total prescription expenditure differed similarly between the two groups [$11,299 (SD=$2,120) for SGLT2i versus $8,496 (SD=$1,548) for DPP4i, p<0.0001]. When subtracting prescription costs, patients taking an SGLT2i had lower annual health care utilization expenditures compared to patients taking a DPP4i [$8,570 (SD=$3,636) versus $9,385 (SD=$3,702), p=0.0188]. Patients with T2DM taking SGLT2i plus metformin had higher total health care and prescription expenditures but lower health care utilization costs compared to DPP4i plus metformin.
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