Long-Term Cost-Effectiveness Analyses of Empagliflozin Versus Oral Semaglutide, in Addition to Metformin, for the Treatment of Type 2 Diabetes in the UK

Abstract

Introduction: International guidelines recommend treatment with a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagonlike peptide-1 (GLP-1) receptor agonist for treatment intensification in type 2 diabetes mellitus (T2DM) patients with progression on metformin. In the randomised, controlled, Digital Features To view digital features for this article go to

Cost-Effectiveness of iGlarLixi in People with Type 2 Diabetes Mellitus Suboptimally Controlled on Basal Insulin Plus Metformin in the UK

“…history of stroke and myocardial infarction [MI]), the lowest utility value was assigned, and event disutilities were then added for events that occur in that year, resulting in an annual utility score for each simulated patient [ 19 ]. Utility and disutility weightings were taken from previously published cost-effectiveness evaluations using the CDM [ 28 ] (see Electronic Supplementary Material [ESM] Table S1).…”

Cost-Effectiveness of iGlarLixi Versus iDegLira in Type 2 Diabetes Mellitus Inadequately Controlled by GLP-1 Receptor Agonists and Oral Antihyperglycemic Therapy

“…For all simulations, QALYs were assessed using the minimum approach, where the lowest-state utility of all concurrent comorbidities was used and disutilities were added for events that occur in that year, resulting in an annual utility score for each simulated patient [ 12 ]. A comprehensive set of utility and disutility weightings were used for each model state and complication experienced, obtained from published literature (ESM Table S2) [ 18 ]. Direct medical costs during each year of therapy in the model were calculated on the basis of drug acquisition costs, glucose monitoring costs, management costs, and costs of T2DM complications (Table 2 ).…”

“…All patients were assumed to be also receiving metformin as oral diabetes therapy concurrently. A comprehensive list of costs associated with complications (including cardiovascular disease [CVD] complications, renal complications, acute events, eye disease, neuropathy, foot ulcer, and amputations) was derived from published literature, based on appropriate UK national sources [ 18 ]. These costs (in 2019, British pound sterling [GBP]) were then applied to each complication or event experienced by patients in the model (ESM Table S3; ESM Fig.…”

“…Log-normal distributions and 20% variation were applied to sample the cost of complications. Treatment effects and utility data were sampled following the beta distribution, based on the estimated standard error detailed in Table 1 (for treatment effects) and on the standard deviation values reported by Ramos et al [ 18 ] (for utilities) (ESM Table S2). For sampling individual baseline characteristics, truncated normal distributions were used following the mean and standard deviations reported in ESM Table S1.…”

Meeting the Challenge of Virtual Diabetes Care: A Consensus Viewpoint on the Positioning and Value of Oral Semaglutide in Routine Clinical Practice

“…Analysis based on a network meta-analysis of PIONEER 2 (oral semaglutide vs. empagliflozin) with the SUSTAIN trials comparing once-weekly semaglutide with sitagliptin, exenatide and canagliflozin (SUSTAIN 2, 3 and 8 respectively) [ 14 , 38 – 40 ] demonstrated that oral semaglutide was strongly cost effective versus empagliflozin as an add-on to other OADs (including metformin) in people with inadequate glycaemic control, with a base-case ICER of £4439 per QALY gained [ 41 ]. Conversely, another cost-effective analysis demonstrated empagliflozin was dominant versus oral semaglutide, in addition to metformin in people with T2D who had experienced hospitalisation for HF, using data from the PIONEER 2 trial [ 42 ]. Given the benefits of SGLT2 inhibitors in people with HF and CKD, the presence of these comorbidities should be considered when evaluating cost-effective options for glycaemic control.…”