Used as first-line therapy, SGLT2 inhibitors and GLP1 receptor agonists could improve outcomes in drug-naive patients with type 2 diabetes, but cost reductions of 70% would be needed to make the agents cost-effective, according to results of an individual-level Monte Carlo–based Markov model. Findings are specific to the U.S. population and costs.
The model used a lifetime horizon and perspective of the health care sector. With outcomes measures of life expectancy, lifetime costs, and incremental cost-effectiveness ratios, the results showed: “First-line SGLT2 inhibitors and GLP1 receptor agonists had lower lifetime rates of congestive heart failure, ischemic heart disease, myocardial infarction, and stroke compared with metformin. First-line SGLT2 inhibitors cost $43,000 more and added 1.8 quality-adjusted months versus first-line metformin ($478,000 per quality-adjusted life-year [QALY]). First-line injectable GLP1 receptor agonists cost more and reduced QALYs compared with metformin.”
Sensitivity analysis showed that to be cost-effective, costs would need to be less than $5 per day for SGLT2 inhibitors and $6 per day for oral GLP1 receptor agonists. “The results of our simulation model and subgroup analyses provide greater clarity about the driving forces of the cost-effectiveness of the various treatment options,” write the authors. “The major driving factors were their high costs and a decrease in quality of life associated with injections. The first-line SGLT2 inhibitor strategy and GLP1 receptor agonist strategies (both oral and injectable) had greater efficacy in terms of life expectancy and [quality-adjusted life expectancy (QALE)] compared with the first-line metformin strategy. Specifically, GLP1 receptor agonists were the most effective strategy to maximize life expectancy, but the injectable form of GLP1 receptor agonists reduced QALE. Our main analysis included the injection disutility as a nontrivial source of concern from the patients’ perspective.”