5 HFrEF is estimated to account for 50–80% of HF cases. 4 HF with reduced ejection fraction (HFrEF), called systolic HF, is defined by a left ventricular ejection fraction ≤40% accompanied by signs of cardiac remodeling and dysfunction. It is estimated that among patients with HF 30–40% have T2D, 3 and among patients with T2D, the risk of HF increases sharply as patients age, with HF prevalence estimates in T2D ranging from 10% to 30%. 2 These comorbidities can result in costly economic impacts both for patients and health care systems.
1 Uncontrolled T2D can lead to complications affecting the cardiovascular, renal, and nervous systems, resulting in comorbidities such as cardiovascular disease, heart failure (HF), renal dysfunction, and retinopathy. 1 Type 2 diabetes (T2D) is the most prevalent form of the disease accounting for 95% of the cases. One out of every 10 US adults, representing 34.2 million individuals, has diabetes. Results show insurance costs for SGLT-2i treatment exceed avoided hospitalization-related insurance costs, but positive benefits exist when costs borne by individuals and their caregivers are considered. This study compares the costs and benefits of SGLT-2i use by US individuals 30 to 64 years old with T2D and systolic heart failure. SGLT-2i use is associated with reductions in heart failure hospitalizations, but within the United States (US) SGLT-2i are expensive medications. Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) are new drugs for managing type 2 diabetes (T2D). Keywords: type 2 diabetes, heart failure, cardiovascular disease, economic impact, cost benefit, net benefit Societal benefits of SGLT-2i use in this population are substantive payer benefits are negative unless SGLT-2i cost is drastically reduced. Lowering SGLT-2i prescription costs 50% and 80% resulted in per person net-benefit increases of $1737 and $4004, respectively.Ĭonclusion: SGLT-2i utilization has steadily increased, with lower HF hospitalization rates observed among SGLT-2i users. In sensitivity analyses, estimated per person base case societal net-benefit of $14,269 was most sensitive to changes in baseline HF hospitalization rates, post-discharge mortality rates, and readmission rates.
Societal perspective net-benefit in 30– 64 population: $5,996,851 ($14,269 per person). Payer perspective overall net-benefit in 30– 64 population: −$1,725,758 (−$4106 per person). Base case scenario net-benefit was negative across all payer perspective models, while positive for societal-perspective. The HF hospitalization rate without SGLT-2i use vs with was 15.5% vs 11.0% (absolute risk reduction of 4.5%). Results: Among adults with T2D and HFrEF age 30– 64, SGLT-2i use increased (1.1% to 17.4%) between 20. Sensitivity analyses were conducted on key parameters.
Societal perspective analyses included indirect costs. Real-world HF hospitalization rates were obtained from claims data (MarketScan Commercial Database, years 2013– 2018). Methods: Economic models included HF hospitalization rates from real-world data (RWD) and hospitalization rate reductions from RWD and SGLT-2i clinical trials. Objective: Study objectives were to assess SGLT-2i utilization and HF hospitalization rates in commercially insured adults (age < 65) with T2D and heart failure with reduced ejection fraction (HFrEF) taking metformin with/without SGLT-2i use and conduct a cost–benefit analysis of SGLT-2i use from payer and societal perspectives. Diabetes guidelines recommend SGLT-2i therapy for patients with HFrEF however, SGLT-2i cost is high. Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) have demonstrated effectiveness in reducing HF hospitalizations in patients with T2D and HF with reduced ejection fraction (HFrEF). Sarah Glover, Matthew E Borrego, Gretchen M Ray, Melissa H RobertsĬollege of Pharmacy, University of New Mexico, Albuquerque, NM, USAĬorrespondence: Melissa H Roberts, College of Pharmacy, University of New Mexico, MSC09 5360, 1 University of New Mexico, Albuquerque, NM, 87131, USA, Tel +1 50, Fax +1 50, Email īackground: Type 2 diabetes (T2D) patients face increased risk of heart failure (HF) as they age.
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