ADA 2021: Economic Benefits of Initiating Empagliflozin vs. GLP-1 Receptor Agonist

The study evaluates the healthcare cost associated with two principal therapies, Empagliflozin and GLP-1 RA, for patients with type 2 diabetes.  

Healthcare costs associated with type 2 diabetes mellitus (T2DM) continue to grow in the United States. The American Diabetes Association (A.D.A.) estimates that roughly $327 billion has been spent on diabetes management in 2017. A large portion of the cost was associated with cardiovascular disease.  

Currently, the ADA recommends multiple antidiabetic options after metformin. However, sodium-glucose cotransporter 2 (SGLT-2) inhibitors or glucagon-like peptide-1 (GLP-1) agonists are recommended for patients living with cardiovascular disease, heart failure, or chronic kidney disease regardless of HbA1c values. Clinical evidence is substantial to support the use of SGLT-2 inhibitors and GLP-1 agonists in patients living with type 2 diabetes mellitus. However, there is limited data on the economic outcomes associated with their use in a real-world setting.  

The objective of this study was to compare healthcare costs associated with empagliflozin (Jardiance) vs. a GLP-1 agonist in patients with type 2 diabetes mellitus. Researchers applied a retrospective matched design to integrated healthcare claims from the IQVIA PharMetrics Plus Claims database. The subjects were adults with T2DM who started either empagliflozin or GLP-1 agonist between August 1, 2014, to September 30, 2018. Significant periods are defined as the index date, pre-index date, and post-index. The index date was determined as the first claim of empagliflozin or GLP-1 agonist. Researchers described the pre-index date as 12 months before the index date with a diagnosis of T2DM. The post-index date was the period from the index date until the earliest discontinuation of therapy.  

Subjects were eligible for the study if they were age 18 or older, T2DM diagnosis with a secondary diagnosis during the pre-index period, continuous enrollment with medical and pharmacy benefits during the pre-index period, and continuous enrollment with medical and pharmacy benefits during the post-index period. Subjects were excluded if they had a diagnosis of pregnancy, gestational diabetes, type 1 diabetes, cancer, end-stage renal disease, H.I.V., or transplant anytime during the pre-index or post-index periods. 

A logistic regression model was applied to estimate the propensity score based on the probability of being in the empagliflozin cohort. The cost was computed as per-patient per month (PPPM) and included both prescription and medical claims. A sub-analysis was conducted with a restricted sample of patients who initiated second-line treatment with either empagliflozin or a GLP-1 agonist after metformin monotherapy.  

74,989 patients were eligible for study criteria. Propensity score matching finalized cohorts to 21,794 patients in the empagliflozin and GLP-1 agonist groups in a 1:1 ratio. Sub-analysis were 5,347 patients in the empagliflozin and GLP-1 agonist groups. Baseline characteristics were balanced, and researchers observed the majority of the patients were male with an average age of 54 years old. Hypertension, dyslipidemia, and cardiovascular disease were the most prevalent comorbid conditions within the population. Post-match, researchers observed that total cost was significantly lower for empagliflozin ($1450) compared to the GLP-1 ($1723) agonist group, with the mean difference being -$273 (P<0.001). Thus, the subgroup analysis was consistent with the preliminary study. However, the difference in medical costs didn’t reach clinical significance.  

This study revealed that patients initiated on empagliflozin had significantly lower pharmacy and medical costs than those started on a GLP-1 agonist. Real-world data from this study may better help physicians with their treatment selection process with patient finances in mind. Therapies not impacted by financial burden can optimize T2DM management. However, this study was limited to a commercially insured population, and generalized findings do not apply to those that do not fall under private insurance. 

Practice Pearls: 

• The total cost of management of T2DM with empagliflozin was significantly lower compared to the GLP-1 agonist. 
• Treatment selection for patient financial status may be beneficial to patient adherence. 
• Generalized findings do not apply to those that do not fall under private insurance. 

Pimple, P et al. (2021, June). Economic Benefits of Initiating Empagliflozin vs. GLP-1 Receptor Agonist Among Patients with Type 2- Diabetes June 2021 

Torré Anderson, II, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health