Estimating the value of sodium‐glucose cotransporter‐2 inhibitors within the context of contemporary guidelines and the totality of evidence

Abstract

AbstractAimsTo comprehensively estimate the cost‐effectiveness of sodium glucose cotransporter‐2 (SGLT2) inhibitor usage in the management of type 2 diabetes mellitus (T2DM) at established clinical review points, incorporating the totality of proven health benefits.Materials and methodsThis study considered the cardio‐ and reno‐protective effects of SGLT2 inhibitors using the Cardiff type 2 diabetes model. Conventional cost‐effectiveness evaluations were undertaken for eligible populations at relevant intensification points reflecting the 2022 guidelines versus the 2015 National Institute of Health and Care Excellence (NICE) guidelines; incremental cost‐effectiveness ratio lifetime trajectories and timepoints for complete cost‐offset were estimated for each pathway. Treatment effects, utility decrements and costs (applied additively and discounted at 3.5%) were sourced from the published literature.ResultsFor all subpopulations on treatment pathways reflecting the NG28‐2022 guidelines, SGLT2 inhibitor introduction was cost‐effective, becoming cost‐saving between 2 and 16 years post‐initiation. Despite increases in pharmacy costs, predicted lifetime costs were lower than for pathways reflecting the NG28‐2015 guidelines, driven by a reduction in heart failure hospitalization and chronic kidney disease costs. Incremental gains in quality‐adjusted life years (ranging from 0.58–1.12) resulted in dominance for the updated NG28‐2022 guidance in all scenarios.ConclusionsOur results show that SGLT2 inhibitors have the potential to lower healthcare costs while improving health outcomes in eligible patient subpopulations.