Cardiovascular and renal outcomes with SGLT2 inhibitors: Real-life observational studies in older patients with type 2 diabetes

Scheen, André

doi:10.1016/j.deman.2023.100135

Cited by 4 publications

(3 citation statements)

References 62 publications

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“…First, as the long‐term efficacy of canagliflozin and dapagliflozin is unknown, we considered an alternative scenario for the long‐term efficacy of these drugs. Specifically, we assumed that their efficacy in lowering MI, stroke, HFH, ACD, dialysis, eGFR and UACR declines would reduce by 3.5% each year after the first 2.5 years (the median follow‐up duration of DAPA‐CKD 48 and CREDENCE trials 2 ) based on the impact of increasing age on the efficacy of SGLT2 inhibitors 49,50 . Second, we assessed the cost‐effectiveness over shorter time horizons of 5, 10 and 20 years (instead of lifetime horizon in the base case).…”

Section: Methodsmentioning

confidence: 99%

“…CKD, chronic kidney disease; CV, cardiovascular; HFH, heart failure hospitalization; MI, myocardial infarction Specifically, we assumed that their efficacy in lowering MI, stroke, HFH, ACD, dialysis, eGFR and UACR declines would reduce by 3.5% each year after the first 2.5 years (the median follow-up duration of DAPA-CKD 48 and CREDENCE trials 2 ) based on the impact of increasing age on the efficacy of SGLT2 inhibitors. 49,50 Second, we assessed the cost-effectiveness over shorter time horizons of 5, 10 and 20 years (instead of lifetime horizon in the base case). As SGLT2 inhibitors reduce CKD progression over time, the use of alternative time horizons could influence the cost-effectiveness of treatment strategies under comparison.…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

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Cost‐effectiveness of canagliflozin and dapagliflozin for treatment of patients with chronic kidney disease and type 2 diabetes

Nguyen

Mital

Bugden

et al. 2023

Diabetes Obesity Metabolism

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AimTo examine the cost‐effectiveness of adding canagliflozin or dapagliflozin to standard of care (SoC) versus SoC alone in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D).Materials and MethodsWe used a Markov microsimulation model to assess the cost‐effectiveness of canagliflozin plus SoC (canagliflozin + SoC), dapagliflozin plus SoC (dapagliflozin + SoC) and SoC alone. Analyses were conducted from a healthcare system perspective. Costs were measured in 2021 Canadian dollars (C$), and effectiveness was measured in quality‐adjusted life‐years (QALYs).ResultsOver a patient's lifetime, canagliflozin + SoC and dapagliflozin + SoC yielded cost savings of C$33 460 and C$26 764 and generated 1.38 and 1.44 additional QALYs compared with SoC alone, respectively. While QALY gains with dapagliflozin + SoC were higher than those with canagliflozin + SoC, this strategy was also more costly with the incremental cost‐effectiveness ratio exceeding the willingness to pay threshold of C$50 000 per QALY. Dapagliflozin + SoC, however, generated cost savings and QALY gains compared with canagliflozin + SoC over shorter time horizons of 5 or 10 years.ConclusionsDapagliflozin + SoC was not cost‐effective versus canagliflozin + SoC in patients with CKD and T2D over the lifetime horizon. However, adding canagliflozin or dapagliflozin to SoC was less costly and more effective relative to SoC alone for treatment of CKD and T2D.

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Section: Methodsmentioning

confidence: 99%

Section: Cost-effectiveness Analysismentioning

confidence: 99%

Cost‐effectiveness of canagliflozin and dapagliflozin for treatment of patients with chronic kidney disease and type 2 diabetes

Nguyen

Mital

Bugden

et al. 2023

Diabetes Obesity Metabolism

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“…In people with established cardiovascular disease or at high risk for cardiovascular disease, GLP-1 RA and SGLT2i have been recommended by the consensus reports of the ADA and the EASD since 2018 [36]. This recommendation was based upon established cardiovascular disease benefit as demonstrated in clinical trials and observational studies [13,14,[37][38][39]. That so few patients were subsequently prescribed GLP-1 RA following incident stroke in the present study (6.6%) likely reflects the lack of recommendations for the use of these treatments to prevent cardiovascular disease in most of the years covered by this study [6].…”

Section: Relation To Previous Studiesmentioning

confidence: 99%

Incidence of stroke, subsequent clinical outcomes and health care resource utilization in people with type 2 diabetes: a real-world database study in France: “INSIST” study

Mohammedi,

Fauchier,

Quignot

et al. 2024

Cardiovasc Diabetol

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Background People with type 2 diabetes (T2D) are at elevated risk of cardiovascular disease (CVD) including stroke, yet existing real-world evidence (RWE) on the clinical and economic burden of stroke in this population is limited. The aim of this cohort study was to evaluate the clinical and economic burden of stroke among people with T2D in France. Methods We conducted a retrospective RWE study using data from the nationally representative subset of the French Système National des Données de Santé (SNDS) database. We assessed the incidence of stroke requiring hospitalization between 2012 and 2018 among T2D patients. Subsequent clinical outcomes including CVD, stroke recurrence, and mortality were estimated overall and according to stroke subtype (ischemic versus hemorrhagic). We also examined the treatment patterns for glucose-lowering agents and CVD agents, health care resource utilization and medical costs. Results Among 45,331 people with T2D without baseline history of stroke, 2090 (4.6%) had an incident stroke requiring hospitalization. The incidence of ischemic stroke per 1000 person-years was 4.9-times higher than hemorrhagic stroke (6.80 [95% confidence interval (CI) 6.47–7.15] versus 1.38 [1.24–1.54]). During a median follow-up of 2.4 years (interquartile range 0.6; 4.4) from date of index stroke, the rate of CVD, stroke recurrence and mortality per 1000 person-years was higher among hemorrhagic stroke patients than ischemic stroke patients (CVD 130.9 [107.7–159.0] versus 126.4 [117.2–136.4]; stroke recurrence: 86.7 [66.4–113.4] versus 66.5 [59.2–74.6]; mortality 291.5 [259.1–327.9] versus 144.1 [134.3–154.6]). These differences were not statistically significant, except for mortality (adjusted hazard ratio 1.95 [95% CI 1.66–2.92]). The proportion of patients prescribed glucagon-like peptide-1 receptor agonists increased from 4.2% at baseline to 6.6% during follow-up. The proportion of patients prescribed antihypertensives and statins only increased slightly following incident stroke (antihypertensives: 70.9% pre-stroke versus 76.7% post-stroke; statins: 24.1% pre-stroke versus 30.0% post-stroke). Overall, 68.8% of patients had a subsequent hospitalization. Median total medical costs were €12,199 (6846; 22,378). Conclusions The high burden of stroke among people with T2D, along with the low proportion of patients receiving recommended treatments as per clinical guidelines, necessitates a strengthened and multidisciplinary approach to the CVD prevention and management in people with T2D.

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Real-life underuse of SGLT2 inhibitors for patients with type 2 diabetes at high cardiorenal risk

Scheen

2024

Diabetes Epidemiology and Management

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Cardiovascular and renal outcomes with SGLT2 inhibitors: Real-life observational studies in older patients with type 2 diabetes

Cited by 4 publications

References 62 publications

Cost‐effectiveness of canagliflozin and dapagliflozin for treatment of patients with chronic kidney disease and type 2 diabetes

Cost‐effectiveness of canagliflozin and dapagliflozin for treatment of patients with chronic kidney disease and type 2 diabetes

Incidence of stroke, subsequent clinical outcomes and health care resource utilization in people with type 2 diabetes: a real-world database study in France: “INSIST” study

Real-life underuse of SGLT2 inhibitors for patients with type 2 diabetes at high cardiorenal risk

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