Simulated cost-effectiveness of SGLT2 inhibitors versus DPP-4 inhibitors

This simulated model-based analysis sought to compare the cost-effectiveness of SGLT2 inhibitors and DPP-4 inhibitors in people with type 2 diabetes in Taiwan. Outcomes and treatment effects were modelled using data from Taiwan’s National Health Insurance Research Database, to include stable users of SGLT2 inhibitors or DPP-4 inhibitors identified in 2017 and followed up to 2019. The hypothetical cohort comprised people with type 2 diabetes of 8 years’ duration who initiated the study drugs at 55 years of age. The model simulated direct healthcare costs and quality-adjusted life-years (QALYs) over 10 years. Cost-effectiveness was judged using incremental cost-effectiveness ratios (ICERs), defined as incremental total healthcare costs divided by incremental total QALYs.

The cohort was divided into those with and without a history of cardiovascular disease (CVD). Over the 10-year simulation, compared with DPP-4 inhibitors, SGLT2 inhibitors yielded ICERs of US$3244 and $4186 per QALY gained in people with and without CVD, respectively. The results were robust across a number of sensitivity analyses, including increased/decreased treatment effects and costs. Throughout the simulations, ICERs were lower (i.e. more cost-effective) for those with pre-existing CVD; however, SGLT2 inhibitors were consistently cost-effective irrespective of CVD history.

This study is limited by the fact that the model did not incorporate data on other outcomes, such as renal disease, adverse effects and weight loss, and that it could only simulate direct costs to the healthcare system and not individual or societal costs. It is thus possible that the cost-effectiveness of SGLT2 inhibitors was underestimated. Nonetheless, the authors conclude that SGLT2 inhibitors are highly cost-effective compared with DPP-4 inhibitors in people with type 2 diabetes regardless of CVD history.

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