PDB71 - ASSESSING THE RELATIVE COST-EFFECTIVENESS OF EMPAGLIFLOZIN AND CANAGLIFLOZIN FOR THE TREATMENT OF TYPE 2 DIABETES PATIENTS WITH EXISTING CARDIOVASCULAR DISEASE IN THE UK

Abstract

This study aimed to determine the relative cost-effectiveness of the sodium-glucose co-transporter-2 (SGLT-2) inhibitors empagliflozin and canagliflozin for the treatment of UK patients with type 2 diabetes (T2D) and established cardiovascular (CV) disease. A published model was used to simulate the treatment of T2D based on the UKPDS risk equations. This was used to extrapolate the clinical outcomes of the EMPA-REG OUTCOME and CANVAS trials for empagliflozin and canagliflozin, respectively, and compare the long-term economic impact from the UK NHS perspective. Hazard ratios (HRs) derived by Bucher indirect treatment comparison were used to simulate rates of the following clinical events: non-fatal myocardial infarction (MI), non-fatal stroke, hospitalisation for heart failure, CV-related mortality, progression of albuminuria, and a composite renal outcome. Adverse events included amputation, bone fracture, genital infection and renal injury. In the base case, HRs for non-significant outcomes were set to 1; absolute HRs were tested in a sensitivity analysis. Quality of life was captured via a baseline utility value, with permanent decrements associated with each event experienced. Treatment and disease management costs were derived from published sources. A lifetime horizon was used, with costs and QALYs discounted at 3.5%pa. In the base case analysis, each patient receiving empagliflozin was predicted to gain 0.99 life years (undiscounted) and 0.43 QALYs (discounted) versus canagliflozin. The predicted gain in life years resulted in a net incremental cost of £585 per patient over the horizon modelled; nevertheless, due to quality of life gains, an incremental cost-effectiveness ratio (ICER) of £1,376/QALY versus canagliflozin was estimated. Sensitivity analyses demonstrated that the ICER was relatively insensitive to varying key model parameters (remained <£8,000/QALY). Empagliflozin is expected to be cost-effective versus canagliflozin for the treatment of UK patients with T2D and established CV disease. This conclusion appears robust in various sensitivity analyses.