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Cost-Effectiveness of SGLT2 Inhibitors in a Real-World Population: A MICADO Model-Based Analysis Using Routine Data from a GP Registry

Author

Listed:
  • Xinyu Li

    (University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy)

  • Rudolf Hoogenveen

    (National Institute for Public Health and the Environment)

  • Mohamed El Alili

    (Vrije Universiteit Amsterdam
    Zorginstituut Nederland)

  • Saskia Knies

    (Zorginstituut Nederland
    Erasmus University Rotterdam)

  • Junfeng Wang

    (Utrecht University)

  • Joline W. J. Beulens

    (Location Vrije Universiteit
    Amsterdam Cardiovascular Sciences
    Utrecht University)

  • Petra J. M. Elders

    (Amsterdam Cardiovascular Sciences
    Location Vrije Universiteit)

  • Giel Nijpels

    (Amsterdam Cardiovascular Sciences)

  • Anoukh Giessen

    (National Institute for Public Health and the Environment)

  • Talitha L. Feenstra

    (University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy
    National Institute for Public Health and the Environment)

Abstract

Objective Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been shown to reduce the risk of cardiovascular complications, which largely drive diabetes’ health and economic burdens. Trial results indicated that SGLT2i are cost effective. However, these findings may not be generalizable to the real-world target population. This study aims to evaluate the cost effectiveness of SGLT2i in a routine care type 2 diabetes population that meets Dutch reimbursement criteria using the MICADO model. Methods Individuals from the Hoorn Diabetes Care System cohort (N = 15,392) were filtered to satisfy trial inclusion criteria (including EMPA-REG, CANVAS, and DECLARE-TIMI58) or satisfy the current Dutch reimbursement criteria for SGLT2i. We validated a health economic model (MICADO) by comparing simulated and observed outcomes regarding the relative risks of events in the intervention and comparator arm from three trials, and used the validated model to evaluate the long-term health outcomes using the filtered cohorts’ baseline characteristics and treatment effects from trials and a review of observational studies. The incremental cost-effectiveness ratio (ICER) of SGLT2i, compared with care-as-usual, was assessed from a third-party payer perspective, measured in euros (2021 price level), using a discount rate of 4% for costs and 1.5% for effects. Results From Dutch individuals with diabetes in routine care, 15.8% qualify for the current Dutch reimbursement criteria for SGLT2i. Their characteristics were significantly different (lower HbA1c, higher age, and generally more preexisting complications) than trial populations. After validating the MICADO model, we found that lifetime ICERs of SGLT2i, when compared with usual care, were favorable (

Suggested Citation

  • Xinyu Li & Rudolf Hoogenveen & Mohamed El Alili & Saskia Knies & Junfeng Wang & Joline W. J. Beulens & Petra J. M. Elders & Giel Nijpels & Anoukh Giessen & Talitha L. Feenstra, 2023. "Cost-Effectiveness of SGLT2 Inhibitors in a Real-World Population: A MICADO Model-Based Analysis Using Routine Data from a GP Registry," PharmacoEconomics, Springer, vol. 41(10), pages 1249-1262, October.
    • Handle: RePEc:spr:pharme:v:41:y:2023:i:10:d:10.1007_s40273-023-01286-3
    DOI: 10.1007/s40273-023-01286-3
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    References listed on IDEAS

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    1. Jan Barendregt & Gerrit Van Oortmarssen & Ben Van Hout & Jacqueline M. Van Den Bosch & Luc Bonneux, 1998. "Coping with multiple morbidity in a life table," Mathematical Population Studies, Taylor & Francis Journals, vol. 7(1), pages 29-49.
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