Assessing the cost-effectiveness of sodium-glucose cotransporter-2 inhibitors in type 2 diabetes mellitus: a comprehensive economic evaluation using clinical trial and real-world evidence
Abstract
Aims The economic burden of diabetes is driven by the management of vascular complications. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated reductions in cardiovascular and renal complications, including hospitalization for heart failure (HHF) and renal disease progression, in randomized clinical trials. The objective of this study was to evaluate the cost-effectiveness of the SGLT2i class versus standard of care in type 2 diabetes mellitus (T2DM), using evidence from both clinical trial and real-world studies. Methods An established T2DM model was adapted to use contemporary outcomes evidence from real-world studies and randomized controlled trial evaluations of SGLT2i, and extrapolated over a lifetime for HHF, myocardial infarction, stroke, end-stage renal disease and all-cause mortality. The economic analysis considered adults with T2DM, with and without established cardiovascular disease, and was conducted over a lifetime from the perspective of the health care payer in the United Kingdom, United States and China, discounted at country-specific rates. Results SGLT2i were consistently associated with increased treatment costs, reduced complication costs and gains in quality-adjusted life years driven by differences in projected life expectancy, cardiovascular and microvascular morbidity and weight loss. SGLT2i were estimated to be cost-saving or cost-effective at relevant thresholds for the overall population in the United Kingdom, United States and Ch…
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Analysis of real-world evidence together with cardiovascular outcome trial data found that SGLT2i use was cost-effective in the United States, primarily attributable to kidney benefits, even though costs for SGLT2i were much higher than in the United Kingdom, China, and Canada.
“Additionally, analysis of real-world evidence together with cardiovascular outcome trial data found that SGLT2i use was cost-effective in the United States (US), also primarily attributable to kidney bene fi ts, even though costs for SGLT2i were much higher than in the United Kingdom, China, and Canada.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [139]
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- Authors
- McEwan, P., Bennett, H., Khunti, K., Wilding, J., Edmonds, C., Thuresson, M., Wittbrodt, E., Fenici, P., & Kosiborod, M.
- Affiliations
- Health Economics and Outcomes Research (United Kingdom) (GB)
- University of Leicester (GB)
- Aintree University Hospital (GB)
- AstraZeneca (United States) (US)
- Statisticon (Sweden) (SE)
- AstraZeneca (United Kingdom) (GB)
- UNSW Sydney (AU)
- Corresponding author
- McEwan, Phil
- ORCID
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2020-09-02
- Volume
- 22
- Issue
- 12
- Pages
- 2364-2374
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W3046450221
- Cited by
- 58
- References
- 47
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 10 · 2022: 14 · 2021: 14 · 2020: 2
- FWCI
- 7.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- SGLT2 inhibitors, type 2 diabetes, cost-effectiveness, heart failure hospitalization, end-stage renal disease, cardiovascular complications, quality-adjusted life years, real-world evidence, economic burden of diabetes, microvascular complications
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Adult, China, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Glucose, United Kingdom, Humans, Hypoglycemic Agents, Sodium
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