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Swapnil N. Rajpathak Part 2, Cost Effectiveness Of DPP-4 Inhibitors

In part 2 of this Exclusive Interview, Dr. Swapnil N. Rajpathak talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about the cost effectiveness of DPP-4 inhibitors, and the ultimate savings in the use of DPP4s — reduced risk of hypoglycemia.

Swapnil N. Rajpathak, MD, MPH, DrPH is Executive Director for the Center for Observational and Real World Evidence at Merck.

Transcript of this video segment:

Steve: So in your study, you discovered that there is actual cost savings when you compared cost (of DPP4s) to a sulfonylurea, which is 30 cents to a dollar. Most pharmacies, they charge. Some pharmacies, it’s free. Compared to the DPP4’s, the cost difference is obviously due to the increased risk of hypoglycemia. So that’s what you were comparing. And you found that there is an actual cost savings in spending more money for the DPP4’s because you can actually prevent more hypoglycemia, which is a much greater cost.

Swapnil: So that level of information may not come directly from the abstract that we present here. But it is true that if there are patients on DPP4’s and you are reducing their costs related to hypoglycemia. iI is cost saving (compared to) if had they used SU. What we did was we took an enhanced sample and tried to understand national level data on DPP4 users and SU users, and we tried to quantify this burden. We did come up with a number, but that number is an underestimate given that we looked at a very short period of time. The study was conducted only for a 1-year time period. Most patients, when they get drug for diabetes, they are obviously on the drug for a longer period of time. And there are some limitations in terms of the general rate of hypoglycemia that we were able to document. So hypoglycemia, as you know, is not very well documented in databases. We are only able to quantify based on what was reported in the system. And most likely it is the severe events that get documented. So there are a lot of events of hypoglycemia that is not quantified. But even with that caveat, we did find a substantial cost savings from the use of DPP4’s compared to SU’s.

Steve: When looking at a drug, we not only look at hypoglycemia, even more importantly we look at the reduction of blood sugars and the reduction of A1c that has to be part of the equation. You can be saving a million dollars by preventing hypoglycemia, but their blood sugars go up. Really at this point, it doesn’t make a difference. You are not going to use a drug that has those issues. Any drug in the market today in order to get approved by the FDA for “diabetes” obviously it has to show a reduction of blood sugars.

Swapnil: Yes, absolutely right. For the study that was done here, it was specifically on hyperglycemia, so that’s the reason I am sharing with you, but you are right different drugs have different clinical profiles and as the clinical guidelines suggest, the physician has to make a decision based on the… tailor the therapy to the patients based on their comorbidities and some other factors. So for DPP4s and SUs this study was only focused on hyperglycemia. Of course there are other advantages or disadvantages of using a specific drug class in a patient with diabetes and that’s a clinical decision that should be based on the guidelines.

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