Model-based predictions on health benefits and budget impact of implementing empagliflozin in people with type 2 diabetes and established cardiovascular disease

Nilsson K, Andersson E, Persson S, Karlsdotter K, Skogsberg J, Gustavsson S, Jendle J, Steen Carlsson K

This is one of IHE’s two new studies focusing on people with type 2 diabetes and established cardiovascular disease in Sweden that have been published in the medical journal “Diabetes, Obesity and Metabolism”. The first study was a registry study of hospital-based care, work absence, associated costs, and mortality in patients with type 2 diabetes with and without established cardiovascular disease (eCVD) compared to matched controls. The current study builds on the results of the registry study and conducts a model-based analysis.

The Swedeheart quality registry reported in 2021 that less than half of people with type 2 diabetes who had a heart attack received diabetes drugs with more effective cardiovascular protection. The aim of this study was therefore to investigate what short- and long-term effects on health, costs and cost-effectiveness an increased use of one of these drugs, empagliflozin, would entail for people with type 2 diabetes and established cardiovascular disease in Sweden.

The validated Institute for Health Economics Diabetes Cohort Model (IHE-DCM) was used to estimate health benefits and 3-years’ budget impact, and lifetime costs per quality-adjusted life year (QALY) gained of increased implementation of adding empagliflozin to standard of care (SoC) for people with type 2 diabetes and eCVD in a Swedish setting. Analyses were based on 30 model cohorts with type 2 diabetes and eCVD (n=131,412 at baseline) from national health data registers.

The analysis indicates that increased treatment with empagliflozin can reduce the number of people who suffer from heart failure and cardiovascular death. The calculations show that if all people with type 2 diabetes and established cardiovascular disease used empagliflozin compared with none, over 3 years it would result in a 30 percent reduction in the incidence of cardiovascular death and 28 percent in heart failure. Swedeheart’s recently published annual report for 2022 indicates that the use of diabetes drugs with cardiovascular protection is increasing among those who have had a heart attack, and the figure for the first time is just over 50 percent.

The study is a collaboration and has been carried out by the Institute for Health and Healthcare Economics, IHE, Örebro University and Boehringer Ingelheim AB. The studies were financed by Boehringer Ingelheim AB.

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Diabetes, Obesity and Metabolism 2023;25(3):748-757