Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses.
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| Názov: | Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses. |
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| Autori: | Chong KS; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan., Yang CT; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Wang CC; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan., Ou HT; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan. huangtz@mail.ncku.edu.tw.; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. huangtz@mail.ncku.edu.tw., Kuo S; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.; Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. |
| Zdroj: | PharmacoEconomics [Pharmacoeconomics] 2025 Dec; Vol. 43 (12), pp. 1451-1461. Date of Electronic Publication: 2025 Sep 12. |
| Spôsob vydávania: | Journal Article; Comparative Study |
| Jazyk: | English |
| Informácie o časopise: | Publisher: Adis, Springer International Country of Publication: New Zealand NLM ID: 9212404 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1179-2027 (Electronic) Linking ISSN: 11707690 NLM ISO Abbreviation: Pharmacoeconomics Subsets: MEDLINE |
| Imprint Name(s): | Publication: Auckland : Adis, Springer International Original Publication: Auckland ; Philadelphia : Adis International, c1992- |
| Výrazy zo slovníka MeSH: | Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/economics , Sodium-Glucose Transporter 2 Inhibitors*/economics , Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors*/administration & dosage , Dipeptidyl-Peptidase IV Inhibitors*/economics , Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use , Dipeptidyl-Peptidase IV Inhibitors*/administration & dosage , Models, Economic* , Hypoglycemic Agents*/economics , Hypoglycemic Agents*/therapeutic use, Humans ; Cost-Benefit Analysis ; Quality-Adjusted Life Years ; Middle Aged ; Male ; Female ; Aged ; Taiwan ; Glycated Hemoglobin ; Glomerular Filtration Rate ; Age Factors ; Body Mass Index |
| Abstrakt: | Competing Interests: Declarations. Funding and assistance: This research was supported by funding from the Taiwan Ministry of Science and Technology (Grant MOST 112-2628-B-006-008-MY3, recipient: Huang-Tz Ou; grant MOST 111-2636-B-002-019, recipient: Chi-Chuan Wang). The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of interest: Huang-Tz Ou is an Editorial Board Member of PharmacoEconomics. She was not involved in the selection of peer reviewers for the manuscript nor in any of the subsequent editorial decisions. All authors have no competing interests to declare. Author contributions and guarantor statement: Ou HT and Chong KS have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: all authors. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: Chong KS. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Chong KS. Administrative, technical, or material support: Ou HT, Wang CC. Supervision: Yang CT, Ou HT, Kuo S. Ethics approval: This study was approved by the Research Ethics Committees of National Cheng Kung University Hospital (NCKUH, A-ER-108097) and National Taiwan University Hospital (NTUH, 201808029RSA). Consent to participate: Not applicable Consent for publication: Not applicable Data availability statement: The data are not publicly available due to data privacy restrictions and only available upon request to the authors. Background and Objective: Although heterogeneous treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been revealed, the heterogeneous economic value of SGLT2is in real-world type 2 diabetes (T2D) populations with diverse clinical characteristics remains unclear. We conducted subgroup cost-effectiveness analyses of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) among patients with T2D. Methods: A multi-state transition model was used to estimate the incremental cost-effectiveness ratios (ICERs, in US$ per quality-adjusted life-years [QALYs] gained) and value-based pricing (VBP) among patients with T2D stratified by age, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI) over 5 years and a Lifetime horizon from a healthcare sector perspective, with both costs and quality-adjusted Life years discounted at 3% annually. Model inputs included treatment effects derived from analysis of individual-level data in Taiwan, and health utilities and costs sourced from published Literature of Taiwanese populations. Deterministic and probabilistic sensitivity analyses across subgroups were performed. All costs were standardized to 2022. Results: Over 5 years, the ICERs of SGLT2is versus DPP4is were as follows: age subgroups (< 65 versus ≥ 65 years: $26,520 versus $2298/QALY-gained), eGFR subgroups (60 ~ < 90 versus ≥ 90 ml/min/1.73 m 2 : $7700 versus $12,884/QALY-gained), HbA1c subgroups (< 8.5 versus ≥ 8.5%: $7001 versus $9488/QALY-gained), and BMI subgroups (< 30 versus ≥ 30 kg/m 2 : $7266 versus $9714/QALY-gained). Over a lifetime, the ICERs became lower, ranging from $2369/QALY-gained for those aged ≥ 65 years to $4239/QALY-gained for those aged < 65 years. Over 5 years, the annual VBP of SGLT2is ranged from $310 for those aged < 65 years to $1267 for those aged ≥ 65 years. Conclusions: Our analysis suggests that adopting SGLT2is over DPP4is for T2D is highly cost-effective across patient subgroups, particularly for the elderly and patients with mild renal impairment. (© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.) |
| References: | ElSayed NA, Aleppo G, Aroda VR, et al. 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S140–57. (PMID: 10.2337/dc23-S00936507650) Noseworthy T, Clement F. Health technology reassessment: scope, methodology, and language. Int J Technol Assess Health Care. 2012;28(3):201–2. (PMID: 10.1017/S026646231200035922980695) Liu AYL, Low S, Yeoh E, et al. A real-world study on SGLT2 inhibitors and diabetic kidney disease progression. Clin Kidney J. 2022;15(7):1403–14. (PMID: 10.1093/ckj/sfac044357567329217649) Idris I, Zhang R, Mamza JB, et al. Lower risk of hospitalization for heart failure, kidney disease and death with sodium-glucose co-transporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in type 2 diabetes regardless of prior cardiovascular or kidney disease: a retrospective cohort study in UK primary care. Diabetes Obes Metab. 2021;23(10):2207–14. (PMID: 10.1111/dom.14437339736908518855) Young KG, McInnes EH, Massey RJ, et al. Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors: a systematic review. Commun Med. 2023;3(1):131. (PMID: 10.1038/s43856-023-00359-w3779416610551026) Birkeland KI, Jørgensen ME, Carstensen B, et al. Cardiovascular mortality and morbidity in patients with type 2 diabetes following initiation of sodium-glucose co-transporter-2 inhibitors versus other glucose-lowering drugs (CVD-REAL Nordic): a multinational observational analysis. Lancet Diabetes Endocrinol. 2017;5(9):709–17. (PMID: 10.1016/S2213-8587(17)30258-928781064) Peng Z-Y, Yang C-T, Ou H-T, et al. Cost-effectiveness of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors among patients with type 2 diabetes with and without established cardiovascular diseases: a model-based simulation analysis using 10-year real-world data and targeted literature review. Diabetes Obes Metab. 2022;24(7):1328–37. (PMID: 10.1111/dom.1470835373898) McEwan P, Bennett H, Khunti K, et al. 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. Diabetes Obes Metab. 2020;22(12):2364–74. (PMID: 10.1111/dom.1416232744392) Li X, Hoogenveen R, El Alili M, et al. Cost-effectiveness of SGLT2 inhibitors in a real-world population: a MICADO model-based analysis using routine data from a GP registry. Pharmacoeconomics. 2023;41(10):1249–62. (PMID: 10.1007/s40273-023-01286-33730065210492753) Igarashi A, Maruyama-Sakurai K, Kubota A, et al. Cost-effectiveness analysis of initiating type 2 diabetes therapy with a sodium-glucose cotransporter 2 inhibitor versus conventional therapy in Japan. Diabetes Ther. 2022;13(7):1367–81. (PMID: 10.1007/s13300-022-01270-8357106469240120) Sim R, Chong CW, Loganadan NK, et al. Cost-effectiveness of glucose-lowering therapies as add-on to standard care for people with type 2 diabetes in Malaysia. Value Health Reg Issues. 2023;38:9–17. (PMID: 10.1016/j.vhri.2023.05.00637419012) Breeze P, Brennan A. Valuing trial designs from a pharmaceutical perspective using value-based pricing. Health Econ. 2015;24(11):1468–82. (PMID: 10.1002/hec.310325204721) Garrison LP Jr, Pauly MV, Willke RJ, et al. An overview of value, perspective, and decision context-a health economics approach: an ISPOR special task force report [2]. Value Health. 2018;21(2):124–30. (PMID: 10.1016/j.jval.2017.12.00629477389) Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28. (PMID: 10.1056/NEJMoa150472026378978) Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–57. (PMID: 10.1056/NEJMoa181238930415602) Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57. (PMID: 10.1056/NEJMoa161192528605608) Chong KS, Chang YH, Lin MH, et al. Kidney outcomes with SGLT2is for type 2 diabetes patients: does background treatment with metformin or RASis matter? Front Endocrinol (Lausanne). 2024;15:1329945. (PMID: 10.3389/fendo.2024.132994538994012) Yang CT, Yao WY, Ou HT, et al. Value of GLP-1 receptor agonists versus long-acting insulins for type 2 diabetes patients with and without established cardiovascular or chronic kidney diseases: a model-based cost-effectiveness analysis using real-world data. Diabetes Res Clin Pract. 2023;198:110625. (PMID: 10.1016/j.diabres.2023.11062536924833) Yang CT, Chong KS, Wang CC, et al. Adaptation of risk prediction equations for cardiovascular outcomes among patients with type 2 diabetes in real-world settings: a cross-institutional study using common data model approach. Cardiovasc Diabetol. 2024;23(1):244. (PMID: 10.1186/s12933-024-02320-03898777311238483) Life table of the Taiwanese population in 2020. Ministry of the Interior, Taiwan. https://www.moi.gov.tw/cl.aspx?n=2948 .Accessed 1 Mar 2022. Liu CS, Li CI, Wang MC, Yang SY, Li TC, Lin CC. Building clinical risk score systems for predicting the all-cause and expanded cardiovascular-specific mortality of patients with type 2 diabetes. Diabetes Obes Metab. 2021;23(2):467–79. (PMID: 10.1111/dom.1424033118688) Chiang JI, Hanlon P, Li TC, et al. Multimorbidity, mortality, and HbA1c in type 2 diabetes: a cohort study with UK and Taiwanese cohorts. PLoS Med. 2020;17(5):e1003094. (PMID: 10.1371/journal.pmed.1003094323797557205223) Yang CT, Peng ZY, Chen YC, Ou HT, Kuo S. Cardiovascular benefits with favorable renal, amputation and hypoglycemic outcomes of SGLT-2 inhibitors in type 2 diabetes from the Asian perspective: a population-based cohort study and systematic review. Front Endocrinol (Lausanne). 2022;13:836365. (PMID: 10.3389/fendo.2022.83636535330915) Kuo S, Yang CT, Chen HY, et al. Valuing health states of people with type 2 diabetes: analyses of the nationwide representative linked databases. J Diabetes Investig. 2021;12(9):1749–58. (PMID: 10.1111/jdi.13520335396558409834) Chen HY, Kuo S, Su PF, et al. Health care costs associated with macrovascular, microvascular, and metabolic complications of type 2 diabetes across time: estimates from a population-based cohort of more than 0.8 million individuals with up to 15 years of follow-up. Diabetes Care. 2020;43(8):1732–40. (PMID: 10.2337/dc20-0072324444547372047) List of reimbursed drugs by NHI. https://www.nhi.gov.tw/QueryN_New/QueryN/Query1 . Accessed 28 Dec 2023. Medication utilization analysis. National Health Insurance Administration, Ministry of Health and Welfare, Taiwan. https://www.nhi.gov.tw/ch/cp-2297-94173-2514-1.html . Accessed 28 Dec 2023. Medical consumer price index in Taiwan. National Statistics, R.O.C. (Taiwan). https://nstatdb.dgbas.gov.tw/dgbasAll/webMain.aspx?sys=100&funid=dgmaine . Accessed 28 Dec 2023. Health Technology Assessment of Center for Drug Evaluation, Taiwan. Taiwan Guidelines of Methodological Standards for Pharmacoeconomic Evaluation. https://www.cde.org.tw/HTA/history . Accessed 28 Dec 2022. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925–30. (PMID: 10.2471/BLT.15.164418279942855153921) Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103. (PMID: 10.1001/jama.2016.1219527623463) Husereau D, Drummond M, Augustovski F, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health. 2022;25(1):3–9. (PMID: 10.1016/j.jval.2021.11.135135031096) Palmer AJ, Si L, Tew M, et al. Computer modeling of diabetes and its transparency: a report on the eighth mount hood challenge. Value Health. 2018;21(6):724–31. (PMID: 10.1016/j.jval.2018.02.002299098786659402) Pasternak B, Ueda P, Eliasson B, et al. Use of sodium glucose cotransporter 2 inhibitors and risk of major cardiovascular events and heart failure: Scandinavian register based cohort study. BMJ. 2019;366:l4772. (PMID: 10.1136/bmj.l4772314670446713906) Han SJ, Ha KH, Lee N, et al. Effectiveness and safety of sodium-glucose co-transporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in older adults with type 2 diabetes: a nationwide population-based study. Diabetes Obes Metab. 2021;23(3):682–91. (PMID: 10.1111/dom.1426133236515) Nargesi AA, Jeyashanmugaraja GP, Desai N, et al. Contemporary national patterns of eligibility and use of novel cardioprotective antihyperglycemic agents in type 2 diabetes mellitus. J Am Heart Assoc. 2021;10(13):e021084. (PMID: 10.1161/JAHA.121.021084339982588403287) Eberly LA, Yang L, Eneanya ND, et al. Association of race/ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with diabetes in the US. JAMA Netw Open. 2021;4(4):e216139. (PMID: 10.1001/jamanetworkopen.2021.6139338564758050743) Tang S, Shao H, Ali MK, et al. Recommended and prevalent use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in a national population-based sample. Ann Intern Med. 2023;176(4):582–3. (PMID: 10.7326/M22-30513684865410422868) Drug Expenditure Target (DET) in 2023. Ministry of Health and Welfare, Taiwan. https://www.mohw.gov.tw/cp-6567-73744-1.html . Accessed 28 Dec 2023. Heerspink HJL, Karasik A, Thuresson M, et al. Kidney outcomes associated with use of SGLT2 inhibitors in real-world clinical practice (CVD-REAL 3): a multinational observational cohort study. Lancet Diabetes Endocrinol. 2020;8(1):27–35. (PMID: 10.1016/S2213-8587(19)30384-531862149) Yau K, Dharia A, Alrowiyti I, Cherney DZI. Prescribing SGLT2 inhibitors in patients with CKD: expanding indications and practical considerations. Kidney Int Rep. 2022;7(7):1463–76. (PMID: 10.1016/j.ekir.2022.04.094358123009263228) Leal J, Alva M, Gregory V, et al. Estimating risk factor progression equations for the UKPDS Outcomes Model 2 (UKPDS 90). Diabet Med. 2021;38(10):e14656. (PMID: 10.1111/dme.1465634297424) Antoniou M, Mateus C, Hollingsworth B, Titman A. A systematic review of methodologies used in models of the treatment of diabetes mellitus. Pharmacoeconomics. 2024;42(1):19–40. (PMID: 10.1007/s40273-023-01312-437737454) Gao N, Dakin HA, Holman RR, Lim L-L, Leal J, Clarke P. Estimating risk factor time paths among people with type 2 diabetes and QALY gains from risk factor management. Pharmacoeconomics. 2024;42(9):1017–28. (PMID: 10.1007/s40273-024-01398-43892248811344020) |
| Grant Information: | 112-2628-B-006-008-MY3 Ministry of Science and Technology, Taiwan; 111-2636-B-002-019 Ministry of Science and Technology, Taiwan |
| Substance Nomenclature: | 0 (Sodium-Glucose Transporter 2 Inhibitors) 0 (Dipeptidyl-Peptidase IV Inhibitors) 0 (Glycated Hemoglobin) 0 (Hypoglycemic Agents) |
| Entry Date(s): | Date Created: 20250912 Date Completed: 20251112 Latest Revision: 20251112 |
| Update Code: | 20251113 |
| DOI: | 10.1007/s40273-025-01536-6 |
| PMID: | 40940626 |
| Databáza: | MEDLINE |
Nájsť tento článok vo Web of Science | Abstrakt: | Competing Interests: Declarations. Funding and assistance: This research was supported by funding from the Taiwan Ministry of Science and Technology (Grant MOST 112-2628-B-006-008-MY3, recipient: Huang-Tz Ou; grant MOST 111-2636-B-002-019, recipient: Chi-Chuan Wang). The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of interest: Huang-Tz Ou is an Editorial Board Member of PharmacoEconomics. She was not involved in the selection of peer reviewers for the manuscript nor in any of the subsequent editorial decisions. All authors have no competing interests to declare. Author contributions and guarantor statement: Ou HT and Chong KS have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: all authors. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: Chong KS. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Chong KS. Administrative, technical, or material support: Ou HT, Wang CC. Supervision: Yang CT, Ou HT, Kuo S. Ethics approval: This study was approved by the Research Ethics Committees of National Cheng Kung University Hospital (NCKUH, A-ER-108097) and National Taiwan University Hospital (NTUH, 201808029RSA). Consent to participate: Not applicable Consent for publication: Not applicable Data availability statement: The data are not publicly available due to data privacy restrictions and only available upon request to the authors.<br />Background and Objective: Although heterogeneous treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been revealed, the heterogeneous economic value of SGLT2is in real-world type 2 diabetes (T2D) populations with diverse clinical characteristics remains unclear. We conducted subgroup cost-effectiveness analyses of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) among patients with T2D.<br />Methods: A multi-state transition model was used to estimate the incremental cost-effectiveness ratios (ICERs, in US$ per quality-adjusted life-years [QALYs] gained) and value-based pricing (VBP) among patients with T2D stratified by age, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI) over 5 years and a Lifetime horizon from a healthcare sector perspective, with both costs and quality-adjusted Life years discounted at 3% annually. Model inputs included treatment effects derived from analysis of individual-level data in Taiwan, and health utilities and costs sourced from published Literature of Taiwanese populations. Deterministic and probabilistic sensitivity analyses across subgroups were performed. All costs were standardized to 2022.<br />Results: Over 5 years, the ICERs of SGLT2is versus DPP4is were as follows: age subgroups (< 65 versus ≥ 65 years: $26,520 versus $2298/QALY-gained), eGFR subgroups (60 ~ < 90 versus ≥ 90 ml/min/1.73 m <sup>2</sup> : $7700 versus $12,884/QALY-gained), HbA1c subgroups (< 8.5 versus ≥ 8.5%: $7001 versus $9488/QALY-gained), and BMI subgroups (< 30 versus ≥ 30 kg/m <sup>2</sup> : $7266 versus $9714/QALY-gained). Over a lifetime, the ICERs became lower, ranging from $2369/QALY-gained for those aged ≥ 65 years to $4239/QALY-gained for those aged < 65 years. Over 5 years, the annual VBP of SGLT2is ranged from $310 for those aged < 65 years to $1267 for those aged ≥ 65 years.<br />Conclusions: Our analysis suggests that adopting SGLT2is over DPP4is for T2D is highly cost-effective across patient subgroups, particularly for the elderly and patients with mild renal impairment.<br /> (© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.) |
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| ISSN: | 1179-2027 |
| DOI: | 10.1007/s40273-025-01536-6 |