The cost‐effectiveness of dapagliflozin compared to DPP‐4 inhibitors in the treatment of type 2 diabetes mellitus in the Netherlands

Abstract

Aim When glycaemic control for people with type 2 diabetes is not achieved with metformin and sulfonylurea alone, adding another oral anti‐diabetes drug, such as a sodium–glucose co‐transporter 2 (SGLT2) or dipeptidyl peptidase‐4 (DPP‐4) inhibitor, is an alternative to starting insulin. The aim of this study is to determine the cost‐effectiveness of dapagliflozin (an SGLT2 inhibitor) compared with DPP‐4 inhibitors when added to metformin and sulfonylurea in people with type 2 diabetes in the Netherlands. Methods A cost–utility analysis is performed using the Cardiff diabetes model, a fixed‐time increment stochastic simulation model informed by ‘United Kingdom Prospective Diabetes Study 68’ risk equations. The base‐case analysis uses a 40‐year time horizon, a Dutch societal perspective and differential discounting (4% for costs, 1.5% for effects). Inputs are obtained from the literature and Dutch price lists. Univariate and probabilistic sensitivity analysis are performed. Results Dapagliflozin is dominant compared with DPP‐4 inhibitors, resulting in a €990 cost saving and a 0.28 quality‐adjusted life year gain over 40 years. Cost savings are associated mainly with treatment costs and a reduced incidence of micro‐ and macrovascular complications, among others nephropathy, myocardial infarction and stroke. Results are robust to changes in input parameters. Conclusions Dapagliflozin is a cost‐saving alternative to DPP‐4 inhibitors when added to metformin and sulfonylurea. The incidence of micro‐ and macrovascular complications is lower for people treated with dapagliflozin. Uncertainty around this outcome is low.

Expert Opinion About the Pharmacoeconomic Edge of Low-Cost Dapagliflozin in Type 2 Diabetes Mellitus in Indian Clinical Settings

“…Dapagliflozin is a well-studied molecule with strong evidence of cardiorenal benefits and the cost-effectiveness also makes it a drug of choice for many patients with T2DM. The results of this survey are in accordance with previous cost-effectiveness studies of dapagliflozin where it is demonstrated that dapagliflozin is a cost-saving therapy for patients with T2DM [ 21 ]. Dapagliflozin lowers the incidences of micro-and macro-vascular complications in people with or without T2DM.…”

“…Dapagliflozin lowers the incidences of micro-and macro-vascular complications in people with or without T2DM. Consequently, there is an improvement in the quality of life of T2DM patients when treated with dapagliflozin due to its metabolic aspects, impact on weight (weight reduction), and cardiorenal protection [ 21 ].…”

Cost‐effectiveness of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors among patients with type 2 diabetes with and without established cardiovascular diseases: A model‐based simulation analysis using 10‐year real‐world data and targeted literature review

“…cost‐effective or cost‐saving) in individuals with T2D have been reported in previous studies 32‐34 . This CEA specifically focused on the use of SGLT2is versus DPP4is and the results are comparable with those in the existing literature obtained from the targeted literature review (Table S7 for detailed literature review procedures, Figure S3 for the flow of article selection), which showed that the use of SGLT2is versus DPP4is for T2D is cost‐effective 13‐15,17‐19 or even cost‐saving 12,16,20 . Details of individual study characteristics and ICER results were summarized in Table S8 and Figure S4, respectively.…”

“…[32][33][34] This CEA specifically focused on the use of SGLT2is versus DPP4is and the results are comparable with those in the existing literature obtained from the targeted literature review (Table S7 for detailed literature review procedures, Figure S3 for the flow of article selection), which showed that the use of SGLT2is versus DPP4is for T2D is cost-effective [13][14][15][17][18][19] or even cost-saving. 12,16,20 Details of individual study characteristics and ICER results were summarized in Table S8 and Figure S4, respectively. The probabilities of being cost-effective for using SGLT2is versus DPP4is obtained by PSAs from this study and existing literature ranged from 96% to 100%.…”

Revisión sistemática de la literatura : costo efectividad de intervenciones farmacológicas de los DPP-4i y SGLT-2i para tratamiento de la diabetes tipo 2 en población mayor a 18 años, 2010-2020 aplicada a Colombia

“…Cost-effectiveness of dapagliflozin as add-on to metformin for the treatment of type 2 diabetes mellitus in greece. Clinical DrugInvestigation, 36(8),[649][650][651][652][653][654][655][656][657][658][659]1007/s40261-016-0410-2 van der Linden, N.,Van Olst, S., Nekeman, S., & Uyl-de Groot, C. A. (2021).…”