Most Read Articles
02 Jun 2020
New drug applications approved by US FDA as of 16 - 31 May 2020 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date. 
Pearl Toh, Yesterday
While children with inflammatory bowel disease (IBD) see their conditions improve with biologic therapy, those with ulcerative colitis (UC) tend to have residual disease activity even after clinical remission, according to two separate studies presented at the 2021 Crohn’s and Colitis Congress.

Total healthcare costs just about the same between empagliflozin and DPP-4 inhibitors

Jairia Dela Cruz
19 Jun 2019

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.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Pharmacist - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
02 Jun 2020
New drug applications approved by US FDA as of 16 - 31 May 2020 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date. 
Pearl Toh, Yesterday
While children with inflammatory bowel disease (IBD) see their conditions improve with biologic therapy, those with ulcerative colitis (UC) tend to have residual disease activity even after clinical remission, according to two separate studies presented at the 2021 Crohn’s and Colitis Congress.