Healthcare costs of urinary tract infections and genital mycotic infections among patients with type 2 diabetes mellitus initiated on canagliflozin: a retrospective cohort study

Abstract

Objective: To assess the economic impact of urinary tract infections (UTIs) and genital mycotic infections (GMIs) among patients with type 2 diabetes mellitus (T2DM) initiated on canagliflozin. Methods: Administrative claims data from April 2013 through June 2014 MarketScan V R databases were extracted. Adults with 1 claim for canagliflozin, T2DM diagnosis, and 90 days enrollment before and after canagliflozin initiation were propensity score matched to controls with T2DM initiated on other anti-hyperglycemic agents (AHAs). UTI and GMI healthcare costs were evaluated 90-days postindex and reported as cohort means. Results: Rates of UTI claims 90 days post-index were similar in patients receiving canagliflozin for T2DM (n ¼ 31,257) and matched controls (2.7% vs 2.8%, p ¼ .677). More canagliflozin than control patients had GMI claims (1.2% vs 0.6%, p < .001) and antifungal utilization (5.3% vs 2.6%, p < .001). Mean post-index costs to treat UTIs were lower but not significantly different for canagliflozin patients vs matched controls ($27.61 vs $37.33, p ¼ .150). GMI treatment costs were higher for the canagliflozin cohort ($3.68 vs $2.44, p ¼ .041). Combined costs to treat either UTI and/or GMI averaged $31.29 per patient for the canagliflozin cohort v $39.77 for controls (p ¼ .211). Rates and costs of UTIs and GMIs were higher for females than males, but the canagliflozin vs control trends observed for the overall sample were similar for both sexes. There were no significant cost differences between the canagliflozin and control cohorts among patients aged 18-64. Among patients aged 65 and above, GMI treatment costs were not significantly different, but costs to treat UTIs and either UTI and/or GMI were significantly lower for canagliflozin patients vs controls. Conclusions: In a real-world setting, the costs to payers of treating UTIs and GMIs are generally similar for patients with T2DM initiated on canagliflozin vs other AHAs. ARTICLE HISTORY

Sodium–Glucose Co-Transporter 2 Inhibitors (SGLT2i) Exposure and Outcomes in Type 2 Diabetes: A Systematic Review of Population-Based Observational Studies

“…1, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram) including n = 1,300,184 persons; total follow-up 910,577 person-years. Of these, 21 were funded by academic institutions, public bodies or charity/non-profit organisations and 16 were funded by pharmaceutical companies [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68]. We found six studies that had been prospectively registered with either https:// clinicaltrials.gov/ (five studies [56,58,63,65,67], with two sharing a registration number [56,58]) or EU PAS Register (one study [52]).…”

“…However, another analysis comparing SGLT2i exposure to DPP4i (in older people) found a reduced association for UTI in both men and women (Tables 7.4, S19.4) [42]. Finally, for canagliflozin (vs. non-canagliflozin controls), a neutral association was observed for UTI and also in sensitivity analysis (Tables 7.5, S19.6) [53].…”

“…For canagliflozin, vs. non-canagliflozin controls, there was an elevated association of exposure with GMI overall, but when men and women were analysed separately only women had an elevated association (Tables 7.9, S19.6) [53].…”

“…There was a reduced association with UTI at 30, 90 and 120 days post-initiation overall, with narrow CIs (Table S19.4, Fig. 6; 120 days, other DNS) and in both men and women when analysed separately (DNS) Canagliflozin 7.5 A medium-sized 2017 American cohort study explored the association of canagliflozin exposure vs. non-canagliflozin AHAs on the risk of UTI [53]. There was a neutral association of canagliflozin on UTI with narrow CIs (Table S19.6, Fig.…”

“…The association remained in subgroup analysis for both men and women (but women at higher risk, DNS). Canagliflozin was associated with a higher risk of an antifungal prescription compared to dapagliflozin and empagliflozin exposure (individual drug analysis, DNS) Canagliflozin 7.9 A medium-sized 2017 American cohort study explored the association of canagliflozin vs. non-canagliflozin controls with GMI [53]. There was an increased association overall for GMI (Table S19.6, Fig.…”