Type 2 diabetes mellitus (T2DM) patients treated with either the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin or dipeptidyl peptidase 4 inhibitors (DPP-4i) incur similar overall healthcare costs, according to data from the EMPRISE trial presented at the 79th Scientific Sessions of the American Diabetes Association (ADA 2019).

“Within the first 2 years of EMPRISE, [representing data collected between August 2014 and September 2016], we observed similar total cost, driven by trend towards lower medical and higher pharmacy costs, and lower medication burden in empagliflozin vs DPP-4i initiators,” said one of the study authors Dr Ajinkya Pawar from the Brigham & Women’s Hospital in Boston, Massachusetts in US.

Pawar and colleagues looked at 17,549 propensity-matched pairs of adult T2D patients (mean age, 58.7 years; 46.67 percent female) who initiated empagliflozin or a DPP-4i. The mean HbA1c level was 8.6 percent, and nearly 25 percent of the entire population had a history of cardiovascular disease (CVD).

During a mean follow-up of 5.4 months, total cost of care (medical plus pharmacy) per member per year (PMPY) was 17,771 USD with empagliflozin and 17,814 USD with DPP-4i, resulting in a difference of a mere 43 USD PMPY. [ADA 2019, abstract 1193-P]

Medical costs (inpatient plus outpatient) tended to be lower in the empagliflozin arm (8,932 vs 9,729 USD PMPY; difference, –797 USD PMPY). This was offset, however, by higher pharmacy costs (8,772 vs 7,990 USD PMPY; difference, 782 USD PMPY).

The number of distinct medication prescriptions was slightly lower among empagliflozin initiators (17.5 vs 18.1; incidence rate ratio, 0.97, 95 percent CI, 0.96─0.98).

Likewise, CVD-related medical costs were lower among patients taking the SGLT2 inhibitor (difference, –132 USD PMPY for CVD-related inpatient costs and –134 USD PMPY for CVD-related outpatient costs).

The lower CVD-related medical costs are in line with the findings from the EMPA-REG OUTCOME trial, which showed a 35-percent relative risk reduction in hospitalization for heart failure with empagliflozin vs placebo, when added to standard of care, in patients with T2D and established cardiovascular disease. [N Engl J Med 2015;373:2117-2128]

A separate abstract from the EMPRISE trial has shown that relative to DPP-4i, the SGLT2 inhibitor indeed provides greater reduction in the risks of composite CV (myocardial infarction, stroke and all-cause mortality; hazard ratio [HR], 0.82, 0.62–1.10) and extended CV outcomes (composite plus heart failure hospitalization or coronary revascularization; HR, 0.73, 0.60–0.88). [ADA 2019, abstract 249-OR]

Taken together, the data suggest that while empagliflozin holds superior cardioprotective advantage over DPP-4i in the care of T2DM patients, the overall healthcare costs are just about the same.