Cost-Effectiveness Of Empagliflozin Research Articles

A cost-effectiveness analysis of empagliflozin for heart failure patients across the full spectrum of ejection fraction in Spain: combined results of the EMPEROR-Preserved and EMPEROR-Reduced trials

ABSTRACT Background Heart failure (HF) is a chronic condition with considerable clinical burden for patients and economic burden for healthcare systems. Treatment for HF is typically based on ejection fraction (EF) phenotype. The cost-effectiveness of empagliflozin + standard of care (SoC) compared to SoC has been examined for HF phenotypes below or above 40% EF separately, but not across the full spectrum of EF in Spain. Methods The results of two preexisting, validated, and published phenotype-specific Markov cohort models were combined using a population-weighted approach, reflecting the incidence of each phenotype in the total HF population in Spain. A probabilistic sensitivity analysis was performed by sampling each model’s probabilistic results. Results Empagliflozin + SoC compared to SoC resulted in increased life-years (LYs) (6.48 vs. 6.35), quality-adjusted LYs (QALYs) (4.80 vs. 4.63), and healthcare costs (€19,090 vs. €18,246), over a lifetime time horizon for the combined HF population in Spain. The incremental cost-effectiveness ratio (ICER) was €5,089/QALY. All subgroup, scenario, and probabilistic ICERs were consistently below €10,000/QALY. Conclusions Empagliflozin is the first treatment with established efficacy and cost-effectiveness for HF patients across EF from the perspective of healthcare payers in Spain. Empagliflozin also proved to be cost-effective for all subgroups of patients included in the analysis.

Cost-Effectiveness of Empagliflozin in Combination with Standard Care versus Standard Care Only in the Treatment of Heart Failure Patients in Finland

Sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin has recently been shown to improve the outcomes of heart failure (HF) patients regardless of patient's left ventricular ejection fraction by reducing the combined risk of cardiovascular death or hospitalization for worsening HF. The aim of this study was to assess the cost-effectiveness of adding empagliflozin to the standard care (SC) in comparison to SC only in the treatment of HF in Finland. The assessment was performed in the cost-utility framework using two Markov cohort state-transition models, one for HF with reduced ejection fraction (HFrEF) and one for HF with preserved ejection fraction (HFpEF). The models have been primarily developed based on the EMPEROR-Reduced and EMPEROR-Preserved trials which informed the modelled patient characteristics, efficacy of treatments in terms of associated risks for heart failure hospitalizations, cardiovascular (CV) and non-CV death, treatment related adverse events (AE), and state- and event-specific health-related quality of life weights (EQ-5D). Direct health care costs were estimated from Finnish published references. Cost-effectiveness was assessed from health care payer perspective based on incremental cost-effectiveness ratio (ICER; cost per quality adjusted life-year [QALY] gained) and probability of cost-effectiveness (at willingness-to-pay [WTP] of 35,000 euros/QALY). The ICER was reported as the weighted (HFrEF, 43.5%; HFpEF, 56.5%) average result of the two models. Empagliflozin + SC treatment increased the average quality-adjusted life-expectancy, and treatment costs of HF patients by 0.15 QALYs and 1,594 euros, respectively, when compared to SC. An additional QALY with empagliflozin was thus gained at a cost of 10,621 euros. The probability of empagliflozin + SC being cost-effective compared to placebo + SC was 77.6% and 83.5% with WTP of 35,000 and 100,000 euros/QALY, respectively. Empagliflozin is a cost-effective treatment for patients with HF in the Finnish health care setting.

EE156 Public Health Impact and Cost-Effectiveness of Empagliflozin (JARDIANCE®) in the Treatment of Patients with Heart Failure (HF) with Preserved Ejection Fraction (HFPEF) in France, Based on Emperor-Preserved Clinical Trial

EMPEROR-Preserved was a phase III, randomized and double-blind trial comparing empagliflozin to placebo, both added to Standard of Care (SoC), in patients with HFpEF. Empagliflozin showed a 21%-reduction in combined risks of cardiovascular (CV) death or HF-hospitalization (95%CI: 0.69-0.90, p<0.001) and a 27%-reduction in total number of HF-hospitalizations (95%CI: 0.61-0.88, p<0.001). A Markov model was adapted to assess the impacts of empagliflozin+SoC vs. SoC for HFpEF in France.

Cost-Effectiveness of Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction.

Empagliflozin is the first medication to demonstrate clinical benefit in patients with heart failure with preserved ejection fraction, but its cost-effectiveness is unknown. We aimed to evaluate the cost-effectiveness of adding empagliflozin to standard therapy in patients with heart failure with preserved ejection fraction. A Markov model from the perspective of the Australian health care system was constructed to compare empagliflozin plus standard care to standard care alone among a hypothetical cohort of patients with heart failure with preserved ejection fraction. Clinical probabilities were derived from The EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction). Costs and utilities were derived from published sources. The main outcome was the incremental cost-effectiveness ratio per quality-adjusted life-year gained. Deterministic and probabilistic sensitivity analyses were performed to assess model uncertainty. Costs and benefits were discounted at 5% annually. Over a lifetime, the addition of empagliflozin to standard care prevented 167 heart failure hospitalizations and 155 heart failure-related urgent care visits for every 1000 patients treated and increased mean quality-adjusted survival by 0.16 quality adjusted life-years per patient. Mean lifetime costs in the empagliflozin and standard care groups were AUD$63 218 and AUD$58 478 per patient, respectively. This resulted in an incremental cost-effectiveness ratio of AUD$29 202 per quality adjusted life-year gained. In probabilistic sensitivity analyses, empagliflozin was cost-effective in 85% of 10 000 Monte Carlo simulations at a willingness-to-pay threshold of AUD$50 000 per quality adjusted life-year gained. In patients with heart failure with preserved ejection fraction, adding empagliflozin to standard care is likely to be cost-effective when compared with standard care alone in the Australian health care setting.

Cost-effectiveness of empagliflozin as a treatment for heart failure with reduced ejection fraction: an analysis from the Chinese healthcare perspective.

BackgroundThe effect of empagliflozin on the cardiovascular outcome is consistent in heart failure with reduced ejection fraction (HFrEF) patients regardless of the presence or absence of diabetes. More evidence is needed regarding the cost-effectiveness of empagliflozin in HFrEF patients. This study sought to evaluate the economic outcomes of adding empagliflozin to the standard treatment for HFrEF patients from the perspective of the Chinese healthcare system, and thus to provide information for decision makers.MethodsBased on the EMPEROR-Reduced clinical trial and other published literature data, the direct medical costs and quality-adjusted life years (QALYs) of patients with HFrEF over a 15-year study period were simulated by a Markov model, and the incremental cost-effectiveness ratio (ICER) was calculated. The price of empagliflozin referred to the data released by Menet, the hospitalization expenses and utility values were derived from published studies in China. A one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to evaluate the robustness of the model.ResultsThe results of the cost-effectiveness analysis showed that the cost of the combination arm was $5,220.98, with a utility of 4.86 QALYs, and the cost of the standard arm was $4,873.96, with a utility of 4.68 QALYs, which equated to an ICER of $1,893.59 per QALY gained. The subgroup analysis showed that patients with HFrEF and diabetes in empagliflozin group had a higher QALY (4.62 vs. 4.35) and a lower cost ($5,213.28 vs. $5,958.60) than standard group. The corresponding ICER for non-diabetic patients was $2,568.15 per QALY. Deterministic sensitivity analysis showed robust results. At the willingness-to-pay threshold of 3 times gross domestic product (GDP) per capita ($31,510.57), almost all of the scattered points in three scenarios were below the threshold line.ConclusionsAt a willingness-to-pay threshold of $31,510.57, adding empagliflozin to standard treatment is a very cost-effective option for HFrEF patients with or without diabetes in China.

Cost-Effectiveness of Empagliflozin and Metformin Combination Versus Standard Care as First-Line Therapy in Patients With Type 2 Diabetes Mellitus

ObjectiveSodium-glucose cotransporter 2 inhibitors have been shown to reduce cardiovascular events but are currently not used as the first-line therapy. This study was conducted to evaluate the cost-effectiveness of first-line empagliflozin plus metformin versus metformin monotherapy among Australians with type 2 diabetes mellitus (T2DM) and existing cardiovascular disease (CVD). MethodsA Markov model with 1-year cycles and a 5-year time horizon was constructed to simulate the occurrence of recurrent cardiovascular events among Australians aged 50 to 84 years with T2DM and CVD. Efficacy results were derived from the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose trial. Costs and utilities were drawn from published sources. The evaluation adopted both health care and societal perspectives, with the latter ascribing the Australian government’s “value of statistical life year” (A$213 000) to each year lived by a person. Future outcomes were discounted at 5% annually. Sensitivity analyses were conducted to enhance the robustness of conclusions. ResultsCompared with metformin monotherapy, first-line empagliflozin plus metformin reduced overall cardiovascular events by 0.82% and overall deaths by 7.72% over 5 years. There were 0.2 years of life saved per person and 0.16 quality-adjusted life years gained, at a net health care cost of A$4408. These equated to incremental cost-effectiveness ratios of A$22 076 per year of life saved and A$28 244 per quality-adjusted life year gained. The gains in the value of statistical life year equated to A$42 530 per person, meaning that from a societal perspective, the intervention was cost-saving. ConclusionFirst-line empagliflozin plus metformin may represent a cost-effective strategy for the management of T2DM and CVD in Australia.

Cost-effectiveness of empagliflozin in patients with type 2 diabetes and established cardiovascular disease in China

BackgroundIn several cardiovascular outcome trials (CVOTs), empagliflozin (SGLT-2 inhibitor), sitagliptin (DPP-4 inhibitor) and liraglutide (GLP-1 receptor agonist) + standard of care (SoC) were compared to SoC in patients with type 2 diabetes and established cardiovascular disease (CVD). This study assessed the cost-effectiveness (CE) of empagliflozin + SoC in comparison to sitagliptin + SoC and liraglutide + SoC based on the respective CVOT.MethodsThe IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the CVOT outcomes. EMPA-REG OUTCOME baseline characteristics and CVOT specific treatment effects on risk factors for cardiovascular disease (HbA1c, BMI, blood pressure, lipids) were applied. Three-year observed cardiovascular events of empagliflozin + SoC versus sitagliptin + SoC and liraglutide + SoC were derived from EMPA-REG OUTCOME and an indirect treatment comparison. Relative risk adjustments to calibrate the CDM were obtained after a trial and error process to match as closely the observed and CDM-predicted outcomes. The drug-specific treatment effects were considered up until HbA1c reached 8.5% and treatment switch occurred. After this switch, the United Kingdom Prospective Diabetes Study 82 risk equations predicted events based on co-existing risk factors and treatment intensification to basal bolus insulin were applied. The analysis was conducted from the perspective of the Chinese healthcare system applying 3% discounting. The time horizon was lifelong.ResultsEmpagliflozin + SoC provides additional Quality Adjusted Life years (QALY + 0.564) for an incremental cost of 42,497RMB (US$6053) compared to sitagliptin + SoC, resulting in an Incremental Cost Utility Ratio of 75,349RMB (US$10,732), thus below the willingness-to-pay threshold of 212,676RMB, corresponding to three times the Gross Domestic Product in China (2019). Compared to liraglutide + SoC, empagliflozin + SoC use leads to 0.211QALY gained and cost savings of 71,427RMB (US$10,173) and is as such dominant. Scenario and probabilistic sensitivity analyses demonstrated the robustness of the results.ConclusionResults suggest that empagliflozin + SoC is cost-effective compared to sitagliptin + SoC and liraglutide + SoC at a willingness-to-pay threshold of 212,676RMB ($30,292)/QALY.

Cost-effectiveness of empagliflozin plus metformin vs metformin alone as first-line therapy in patients with type 2 diabetes mellitus: An australian perspective

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

1158-P: Cost-Effectiveness of Empagliflozin vs. Liraglutide as Second-Line Therapy for Type 2 Diabetes in the United States

Background: The ADA’s “Standards of Medical Care in Diabetes” recommends use of an SGLT2 inhibitor or GLP-1 receptor agonist as one of the six drug classes after metformin (MET) in T2D patients. These therapies are preferred among T2D patients with cardiovascular disease (CVD) based on clinical trial results demonstrating significant improvement in clinical outcomes. We sought to examine the economic implications of sequential use of these therapies. Methods: An economic simulation model evaluating treatment in U.S. T2D patients after MET with empagliflozin (EMPA) as 2nd line and liraglutide (LIRA) as 3rd line vs. LIRA as 2nd line and EMPA as 3rd line was used to estimate the lifetime health and cost outcomes of T2D-related complications and adverse events (AEs). Complications, including CV death, myocardial infarction, stroke, and renal outcomes, were predicted using United Kingdom Prospective Diabetes Study risk equations and EMPA-REG OUTCOME data. A meta-analysis informed treatment-induced changes in HbA1c, SBP, and weight in patients without CVD. For each complication in patients with CVD, an indirectly estimated hazard ratio of LIRA vs. EMPA was applied. Costs ($2019), AE rates, and utilities were sourced from published literature. Results: Compared with LIRA as 2nd line, use of EMPA added 0.32 quality-adjusted life-years (QALYs) and led to lower lifetime costs (by $11,422/patient), suggesting dominance over 2nd line LIRA (improved health outcomes at lower cost). These results were similar across CVD subgroups. Patients with CVD at baseline compared to those without CVD showed larger gains in incremental QALYs (0.42 with CVD, 0.29 without CVD) with somewhat lower cost savings (by $9,550, $12,392, respectively) for 2nd line EMPA vs. LIRA, showing dominance in both subpopulations. Conclusion: For T2D patients with and without CVD, the use of EMPA on background MET was a dominant strategy for U.S. payers, associated with improved outcomes and lower costs as compared with LIRA. Disclosure O. Reifsnider: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. P. Pimple: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Employee; Spouse/Partner; CVS Caremark. M.J.D. Stargardter: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. S. Brand: Consultant; Self; Boehringer Ingelheim International GmbH, Boehringer Ingelheim Pharmaceuticals, Inc. N. Desai: None. S. Shetty: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.

Cost-Effectiveness Analysis of Empagliflozin Compared with Canagliflozin or Standard of Care (SoC) in Patients with T2DM and Established Cardiovascular (CV) Disease

Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, is FDA approved to reduce the risk of CV death in adults with T2DM and established CV disease. EMPA-REG OUTCOME showed a significant reduction in major adverse CV event (MACE), CV death, and hospitalization for heart failure (HHF) for empagliflozin vs. placebo in addition to SoC. Recently, CANVAS showed significant reduction in MACE and HHF with canagliflozin vs. placebo in addition to SoC. The objective of this study was to assess the cost-effectiveness of empagliflozin vs. canagliflozin or SoC in patients with T2DM and established CV disease in the U.S. A discrete event simulation model was used to simulate CV, renal, and select adverse events from EMPA-REG OUTCOME. Occurrence of each event was modeled using event-free survival curves with time-dependent covariates. A hazard ratio for canagliflozin vs. empagliflozin on each modeled event was estimated from published CANVAS data and EMPA-REG OUTCOME using an indirect treatment comparison. U.S. costs and utilities were taken from public sources. Patients receiving empagliflozin were predicted to live longer by 0.93 years vs. canagliflozin and 1.86 years vs. SoC due to lower CV death rates. When compared to SoC, empagliflozin had fewer or similar events per 100 patients-years, except for nonfatal stroke (NFST) and genital mycotic infection (GMI). For empagliflozin vs. canagliflozin, there were less amputation (0.58 vs. 1.08), kidney injury (0.33 vs. 0.47), and bone fracture (1.12 vs. 1.45); similar nonfatal myocardial infarction (1.93 vs. 1.85), HHF (1.74 vs. 1.65), albuminuria progression (5.96 vs. 6.14), composite renal outcome (1.16 vs. 1.20), and GMI (1.80 vs. 1.79); but more NFST (1.20 vs. 0.85). Based on a $100,000/QALY threshold, empagliflozin was cost-effective compared with canagliflozin or SoC at $2,932/QALY or $55,489/QALY, respectively. Disclosure A. Kansal: None. O. Reifsnider: Consultant; Self; Evidera. J. Lee: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. K. Fahrbach: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. P. Gandhi: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. E. Pfarr: None. A.V. Ustyugova: Employee; Self; Boehringer Ingelheim GmbH.

PDB45 - Cost-Effectiveness of Empagliflozin in Chinese Patients with Type 2 Diabetes and Established Cardiovascular Disease: A Discrete Event Simulation Economic Modelling Study

To evaluate the cost-effectiveness of empagliflozin when added to standard of care (SoC) in patients with type 2 diabetes (T2D) and established cardiovascular (CV) disease in China. A validated discrete event simulation model, based on time-dependent parametric survival analyses of the EMPA-REG OUTCOME trial data, was used to project individual clinical and economic outcomes of patients receiving empagliflozin plus SoC compared with SoC alone. The model was adapted to the Chinese setting with local cost data from a healthcare system perspective. The background mortalities of the model cohort were adjusted with China-specific parameters. Model extrapolated outcomes included numbers and rates of diabetes-related events, life years (LYs), quality-adjusted life years (QALYs), costs as well as incremental cost-effectiveness ratios (ICERs). The main analysis simulated 5,000 patients over a lifetime horizon. An annual discount rate of 3.5% was applied to both future costs and QALYs. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the model results. Compared with SoC alone, empagliflozin plus SoC was predicted to result in longer mean survivals (14.75 LYs vs 12.36 LYs) and reduced rates of clinical events, including CV death (4.11 vs. 5.78, per 100-patient years), heart failure (2.08 vs. 3.11), nonfatal myocardial infarction (1.94 vs 2.20), renal injury (1.02 vs. 1.56) and renal failure (0.33 vs. 0.56). This resulted in a predicted additional 1.01 QALYs with empagliflozin (8.05 QALYs vs. 7.04 QALYs with SoC) at an incremental cost of ¥58,166 per patient. The generated ICER was ¥57,971 per QALY gained, which was considered highly cost-effective in China given a willingness-to-pay threshold of ¥161,940 per QALY gained (three times GDP per capita). Deterministic and probabilistic sensitivity analyses indicated that the results are robust. Empagliflozin added to SoC is a highly cost-effective treatment strategy for patients with T2D and established CV disease in China.

Cost-Effectiveness of Empagliflozin (Jardiance®) In The Treatment of Patients With Type 2 Diabetes Mellitus (T2DM) In Turkey Based Empa-Reg Outcome Data

Cost-Effectiveness of Empagliflozin (Jardiance®) In The Treatment of Patients With Type 2 Diabetes Mellitus (T2DM) In Turkey Based Empa-Reg Outcome Data

Cost-Effectiveness of Empagliflozin In Patients With Type 2 Diabetes Mellitus At High Cardiovascular Risk In Poland

Cost-Effectiveness of Empagliflozin In Patients With Type 2 Diabetes Mellitus At High Cardiovascular Risk In Poland

PDB52 - Cost Effectiveness of Empagliflozin in Patients with T2DM and High CV Risk in Canada

PDB52 - Cost Effectiveness of Empagliflozin in Patients with T2DM and High CV Risk in Canada

PDB46 - Cost-Effectiveness of Empagliflozin (Jardiance) in the Treatment of Patients with Type 2 Diabetes Mellitus (T2DM) in the UK Based on Empa-Reg Outcome Data

PDB46 - Cost-Effectiveness of Empagliflozin (Jardiance) in the Treatment of Patients with Type 2 Diabetes Mellitus (T2DM) in the UK Based on Empa-Reg Outcome Data