SYSTEMATIC REVIEW OF COST-EFFECTIVENESS OF SGLT-2 INHIBITORS IN TYPE 2 DIABETES MELLITUS
The objective was to systematically review the published cost-effectiveness studies of SGLT-2 inhibitors in the treatment of patients with Type 2 diabetes mellitus (T2DM).
Relevant studies published before 31st March 2019 were identified from major database (PubMed and CEA Registry by Tuft University) and health technology assessment (HTA) report (CADTH database, centre for reviews and dissemination at University of York and Malaysia HTA section). All studies compared both cost and consequences of SGLT-2 inhibitors with at least one alternative. The inclusion criteria are as follows: (i) the study conducted economic evaluation using one of these method: cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and costbenefit analysis (CBA) studies, (ii) full text articles published in English language, (iii) study population was T2DM, and (iv) the intervention drugs under investigation was SGLT-2 inhibitors including Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin, Ipragliflozin, Ipragliflozin, Luseogliflozin and Tofogliflozin.
Total studies recruited was 392 and only 18 was selected. The excluded reasons including the title not relevant (n=347), abstract only (n=17), article with foreign language (n=3), full article not fulfilled criteria (n=5), and systematic review (n=2). Majority of studies (44.4%) were from the United States and followed by China (16.6%) and the United Kingdom (16.6%). Two out of 18 studies using SGLT-2 inhibitors as comparator and the rest of studies using SGLT-2 inhibitors as intervention when conducting economic evaluation analysis. It found that 55.6% of studies using Dapagliflozin as the intervention and followed by Canagliflozin (22.2%) and Empagliflozin (5.5%). The most common comparison antidiabetic agent for SGLT-2 inhibitors was DPP-4 inhibitor (38.9%) and followed by sulfonylurea (27.8%). The finding of studies was SGLT-2 inhibitor was a dominant or cost-effective option. However, a study concluded that Liraglutide 1.2mg and 1.8mg (GLP-1 receptor agonist) was more cost-effectiveness compare to SLGT-2 inhibitor. The reasons for different in findings may be due to (1) the time horizon of the study, (2) the targeted population and (3) method of economic evaluation. Eight out of 18 studies show SGLT-2 inhibitor is a cost-saving antidiabetic agent. Majority of these studies (n=3) compared SGLT-2 inhibitors with DPP-4 inhibitor. The range of incremental cost-effectiveness ratio (ICER) for SGLT-2 inhibitor with the comparator was between USD 2,008.16 per QALY and USD 79,365.13 per QALY gained. From the review, initiated SGLT-2 inhibitor as second-line or third-line antidiabetic agent was estimated a total additional life-year gained of 0.01 to 2.13 for T2DM patient while a total additional quality-adjusted-life-year gained was between 0.0107 and 1.9.
SGLT-2 inhibitor is a cost-effective or dominant option for treating T2DM patients who failed to achieve glycemic control with monotherapy (metformin) and dual therapy (metformin with SU).