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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
Karolinska Inst, Dept Med, Cardiol Unit, Stockholm, Sweden;Capio St Gorans Hosp, Stockholm, Sweden.
AstraZeneca Europe & Canada, Oslo, Norway.ORCID iD: 0000-0001-5423-3967
Soder Sjukhuset, Dept Clin Sci & Educ, Div Internal Med, Unit Diabet Res, Stockholm, Sweden.
Statisticon AB, Uppsala, Sweden.
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2019 (English)In: Diabetes, obesity and metabolism, ISSN 1462-8902, E-ISSN 1463-1326, Vol. 21, no 12, p. 2651-2659Article in journal (Refereed) Published
Abstract [en]

Aims To investigate how the cardiovascular (CV) risk benefits of dapagliflozin translate into healthcare costs compared with other non-sodium-glucose cotransporter-2 inhibitor glucose-lowering drugs (oGLDs) in a real-world population with type 2 diabetes (T2D) that is similar to the population of the DECLARE-TIMI 58 trial. Methods Patients initiating dapagliflozin or oGLDs between 2013 and 2016 in Swedish nationwide healthcare registries were included if they fulfilled inclusion and exclusion criteria of the DECLARE-TIMI 58 trial (DECLARE-like population). Propensity scores for the likelihood of dapagliflozin initiation were calculated, followed by 1:3 matching with initiators of oGLDs. Per-patient cumulative costs for hospital healthcare (in- and outpatient) and for drugs were calculated from new initiation until end of follow-up. Results A total of 24 828 patients initiated a new GLD; 6207 initiated dapagliflozin and 18 621 initiated an oGLD. After matching based on 96 clinical and healthcare cost variables, groups were balanced at baseline. Mean cumulative 30-month healthcare cost per patient was similar in the dapagliflozin and oGLD groups ($11 807 and $11 906, respectively; difference, -$99; 95% CI, -$629, $483; P = 0.644). Initiation of dapagliflozin rather than an oGLD was associated with significantly lower hospital costs (-$658; 95% CI, -$1169, -$108; P = 0.024) and significantly higher drug costs ($559; 95% CI, $471, $648; P < 0.001). Hospital cost difference was related mainly to fewer CV- and T2D-associated complications with use of dapagliflozin compared with use of an oGLD (-$363; 95% CI, -$665, -$61; P = 0.008). Conclusion In a nationwide, real-world, DECLARE-like population, dapagliflozin was associated with lower hospital costs compared with an oGLD, mainly as a result of reduced rates of CV- and T2D-associated complications.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 21, no 12, p. 2651-2659
National Category
Endocrinology and Diabetes
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URN: urn:nbn:se:uu:diva-398852DOI: 10.1111/dom.13852ISI: 000482664900001PubMedID: 31379124OAI: oai:DiVA.org:uu-398852DiVA, id: diva2:1380159
Funder
AstraZenecaAvailable from: 2019-12-18 Created: 2019-12-18 Last updated: 2019-12-18Bibliographically approved

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