Wilson M, Sander S, Kuti E, Lucas A. Cost offsets predicted with empagliflozin in patients with type 2 diabetes and established cardiovascular disease. Poster presented at the 2017 Annual AMCP Conference; March 27, 2017. Denver, CO. [abstract] J Manag Care Spec Pharm. 2017 Mar; 23(3a):S46.


Background: The randomized EMPA-REG OUTCOME trial demonstrated that the addition of empagliflozin (empa) to standard-of-care (SoC) therapy reduced the risk of cardiovascular (CV) outcomes in patients with type 2 diabetes (T2DM) who have established CV disease.

Objective: To model the health-plan cost offsets of empa plus SoC versus SoC only in patients with T2DM and established CV disease.

Methods: We created an economic model to compare the cost offsets associated with treating adult T2DM patients with established CV disease with empa plus SoC versus treating the same patients with SoC only. Patients incurred annual risks for CV outcomes (nonfatal myocardial infarction, nonfatal stroke, or CV death), renal outcomes (continuous renal replacement therapy, acute renal failure, and chronic kidney disease) and adverse events observed in the EMPA-REG OUTCOME trial. Annual costs associated with these outcomes were taken from the published literature. Annual drug costs were estimated based on resource use in the trial and wholesale acquisition costs from Redbook. We modeled a 5-year time horizon to estimate the annual, per-member per-month (PMPM) and per-treated-member per-month (PTMPM) costs and outcomes  for patients receiving empa plus SoC and SoC only. Results were reported as incremental PMPM and PTMPM.

Results: When compared with SoC only, treating a starting population of all 23,220 adult T2DM patients with established CV disease with empa plus SoC was found to have incremental PTMPM total costs of $37.90, $0.25, -$40.13, -$83.51, and -$130.22 in years 1 through 5, respectively. Incremental PMPM total costs were estimated to be $0.88, $0.54, $0.11, -$0.43, and -$1.08 in years 1 through 5, respectively. Over the 5-year period, treating all adult T2DM patients with established CV disease with empa plus SoC was associated with the avoidance of 2,089 CV outcomes (including 966 avoided CV deaths) compared with SoC only.

Conclusions: In adult T2DM patients with established CV disease, use of empa plus SoC was associated with overall healthcare cost savings over a 5-year time horizon, driven by reductions in fewer CV outcomes including CV death.

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