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Published in: Diabetes Therapy 12/2020

Open Access 01-12-2020 | Empagliflozin | Original Research

Implementation of Empagliflozin in Patients with Diabetes Mellitus Type 2 and Established Cardiovascular Disease: Estimation of 5-Year Survival and Costs in Sweden

Authors: Lars Bernfort, Magnus Husberg, Ann-Britt Wiréhn, Ulf Rosenqvist, Staffan Gustavsson, Kristina Karlsdotter, Lars-Åke Levin

Published in: Diabetes Therapy | Issue 12/2020

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Abstract

Introduction

Cardiovascular disease (CVD) affects approximately 30% of patients with diabetes mellitus type 2 (T2D) and leads to increased morbidity, decreased survival and increased healthcare utilization. The aim of this study was to estimate the impact of treating these patients with the sodium–glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on survival and healthcare utilization.

Methods

Actual survival and healthcare utilization data from a 5-year retrospective cohort study on patients with T2D and CVD in the Region of Östergötland, Sweden were used as a starting point. Actual data were adjusted in accordance with risk reductions for mortality and CV events related to empagliflozin treatment as reported in the EMPA-REG OUTCOME study.

Results

Applying the risk reductions related to empagliflozin treatment on the cohort of patients with T2D and CVD in Östergötland resulted in an increase in 5-year survival of 96 days per patient and reduced costs for healthcare and drugs other than empagliflozin. Including the cost of empagliflozin, treatment led to an increased net cost per patient of approximately SEK 18,000 over 5 years.

Conclusion

Empagliflozin treatment would reduce mortality and healthcare utilization in the patient group. The treatment strategy should be considered cost-effective, supporting a broad implementation of empagliflozin for patients with T2D and established CVD, in line with current national and international guidelines.
Literature
1.
go back to reference Huebschmann AG, Huxley RR, Kohrt WM, Zeitler P, Regensteiner JG, Reusch JEB. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia. 2019;62(10):1761–72.CrossRefPubMedPubMedCentral Huebschmann AG, Huxley RR, Kohrt WM, Zeitler P, Regensteiner JG, Reusch JEB. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia. 2019;62(10):1761–72.CrossRefPubMedPubMedCentral
2.
go back to reference Swedish National Board of Health and Welfare, National Guidelines for Diabetes Care—Support for governance and management. Stockholm; 2018 Swedish National Board of Health and Welfare, National Guidelines for Diabetes Care—Support for governance and management. Stockholm; 2018
3.
go back to reference Eliasson B, Ekelund J, Amberntsson R, Miftaraj M, Svensson AM. Cardiovascular disease in patients with type 2 diabetes and in patients starting empagliflozin treatment: nationwide survey. Diabetes Ther. 2019;10(4):1523–30.CrossRefPubMedPubMedCentral Eliasson B, Ekelund J, Amberntsson R, Miftaraj M, Svensson AM. Cardiovascular disease in patients with type 2 diabetes and in patients starting empagliflozin treatment: nationwide survey. Diabetes Ther. 2019;10(4):1523–30.CrossRefPubMedPubMedCentral
4.
go back to reference Bernfort L, Husberg M, Wirehn AB, et al. Disease burden and healthcare costs for T2D patients with and without established cardiovascular disease in Sweden: a retrospective cohort study. Diabetes Ther. 2020;11:1537–49.CrossRefPubMedPubMedCentral Bernfort L, Husberg M, Wirehn AB, et al. Disease burden and healthcare costs for T2D patients with and without established cardiovascular disease in Sweden: a retrospective cohort study. Diabetes Ther. 2020;11:1537–49.CrossRefPubMedPubMedCentral
5.
go back to reference Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–32323.CrossRefPubMed Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–32323.CrossRefPubMed
6.
go back to reference Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487–93.CrossRefPubMed Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487–93.CrossRefPubMed
7.
go back to reference Kristensen SL, Rorth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019;7(10):776–85.CrossRefPubMed Kristensen SL, Rorth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019;7(10):776–85.CrossRefPubMed
8.
go back to reference Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393(10166):31–9.CrossRefPubMed Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393(10166):31–9.CrossRefPubMed
9.
go back to reference Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295–306.CrossRefPubMed Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295–306.CrossRefPubMed
10.
go back to reference Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–288.CrossRefPubMed Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–288.CrossRefPubMed
11.
go back to reference Patorno E, Pawar A, Franklin JM, et al. Cardiovascular effectiveness of empagliflozin compared to DPP4 inhibitors and to GLP1 receptor agonists: interim analysis from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Circulation. 2019;140(Suppl 1):Abstract 11928. Patorno E, Pawar A, Franklin JM, et al. Cardiovascular effectiveness of empagliflozin compared to DPP4 inhibitors and to GLP1 receptor agonists: interim analysis from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Circulation. 2019;140(Suppl 1):Abstract 11928.
12.
go back to reference Najafzadeh M, Pawar A, Schneeweiss S, et al. Healthcare resource utilization among empagliflozin initiators with and without cardiovascular disease versus DPP4i in a commercially-insured routine care population: an analysis from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Circulation. 2019;140(Suppl 1):Abstract 13655. Najafzadeh M, Pawar A, Schneeweiss S, et al. Healthcare resource utilization among empagliflozin initiators with and without cardiovascular disease versus DPP4i in a commercially-insured routine care population: an analysis from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Circulation. 2019;140(Suppl 1):Abstract 13655.
13.
go back to reference Levin LA, Wallentin L, Bernfort L, et al. Health-related quality of life of ticagrelor versus clopidogrel in patients with acute coronary syndromes—results from the PLATO trial. Value Health. 2013;16(4):574–80.CrossRefPubMed Levin LA, Wallentin L, Bernfort L, et al. Health-related quality of life of ticagrelor versus clopidogrel in patients with acute coronary syndromes—results from the PLATO trial. Value Health. 2013;16(4):574–80.CrossRefPubMed
14.
go back to reference Swedish National Board of Health and Welfare, National Guidelines for the Diabetes Care 2010—Support for governance and management, Appendix 4, Method. Stockholm; 2010. Swedish National Board of Health and Welfare, National Guidelines for the Diabetes Care 2010—Support for governance and management, Appendix 4, Method. Stockholm; 2010.
15.
16.
go back to reference Persson F, Bodegard J, Lahtela JT, et al. Different patterns of second-line treatment in type 2 diabetes after metformin monotherapy in Denmark, Finland, Norway and Sweden (D360 Nordic): a multinational observational study. Endocrinol Diabetes Metab. 2018;1(4):e00036.CrossRefPubMedPubMedCentral Persson F, Bodegard J, Lahtela JT, et al. Different patterns of second-line treatment in type 2 diabetes after metformin monotherapy in Denmark, Finland, Norway and Sweden (D360 Nordic): a multinational observational study. Endocrinol Diabetes Metab. 2018;1(4):e00036.CrossRefPubMedPubMedCentral
18.
go back to reference Parker ED, Wittbrodt ET, McPheeters JT, Frias JP. Comparison of healthcare resource utilization and costs in patients with type 2 diabetes initiating dapagliflozin versus sitagliptin. Diabetes Obes Metab. 2019;21(2):227–33.CrossRefPubMed Parker ED, Wittbrodt ET, McPheeters JT, Frias JP. Comparison of healthcare resource utilization and costs in patients with type 2 diabetes initiating dapagliflozin versus sitagliptin. Diabetes Obes Metab. 2019;21(2):227–33.CrossRefPubMed
19.
go back to reference Norhammar A, Bodegard J, Nystrom T, et al. Dapagliflozin vs non-SGLT-2i treatment is associated with lower healthcare costs in type 2 diabetes patients similar to participants in the DECLARE-TIMI 58 trial: a nationwide observational study. Diabetes Obes Metab. 2019. https://www.ncbi.nlm.nih.gov/pubmed/31379124. Accessed 5 Aug. Norhammar A, Bodegard J, Nystrom T, et al. Dapagliflozin vs non-SGLT-2i treatment is associated with lower healthcare costs in type 2 diabetes patients similar to participants in the DECLARE-TIMI 58 trial: a nationwide observational study. Diabetes Obes Metab. 2019. https://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​31379124. Accessed 5 Aug.
20.
go back to reference Arbel R, Aboalhasan E, Hammerman A, Azuri J. Sodium-glucose cotransporter 2 inhibitors for prevention of heart failure events in patients with type 2 diabetes mellitus: a cost per outcome analysis. Clin Drug Investig. 2020;40(7):665–9. Arbel R, Aboalhasan E, Hammerman A, Azuri J. Sodium-glucose cotransporter 2 inhibitors for prevention of heart failure events in patients with type 2 diabetes mellitus: a cost per outcome analysis. Clin Drug Investig. 2020;40(7):665–9.
21.
go back to reference Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375(4):323–34.CrossRefPubMed Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375(4):323–34.CrossRefPubMed
Metadata
Title
Implementation of Empagliflozin in Patients with Diabetes Mellitus Type 2 and Established Cardiovascular Disease: Estimation of 5-Year Survival and Costs in Sweden
Authors
Lars Bernfort
Magnus Husberg
Ann-Britt Wiréhn
Ulf Rosenqvist
Staffan Gustavsson
Kristina Karlsdotter
Lars-Åke Levin
Publication date
01-12-2020
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 12/2020
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-020-00937-4

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