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Dapagliflozin add-on therapy more cost-effective than sitagliptin
Among adults initiating type 2 diabetes therapy, dapagliflozin and sitagliptin were associated with similar costs over 1 year, but among those adding either agent to established oral monotherapy, dapagliflozin was the more cost-effective choice, according to data published in Diabetes, Obesity and Metabolism.
“Although treatment must always be individualized and depends on many factors, this retrospective, real-world study supports the use of SGLT2 inhibitors as initial add-on therapy in patients suboptimally controlled on metformin monotherapy,” Juan Pablo Frias, MD, FACE, president and CEO of the National Research Institute in Los Angeles, told Endocrine Today.
Frias and colleagues examined medical and pharmacy claims and enrollment information from two U.S. commercial claims databases and Medicare Part D to compare health care costs and utilization of adults with type 2 diabetes who initiated the SGLT2 inhibitor dapagliflozin (Farxiga, AstraZeneca) or the DPP-IV inhibitor sitagliptin (Januvia, Merck) from 2014 to April 2015 (n = 2,722 in each cohort; mean age, 53 years).
At 1-year follow-up, those who started sitagliptin had more all-cause office visits (11.3 vs. 10.5; P = .003), all-cause outpatient visits (4.3 vs. 3.5; P < .001), all-cause inpatient stays (0.1 vs. 0.09; P = .029) and diabetes-related office visits (4.6 vs. 4.4; P = .003). Those who started dapagliflozin had filled more all-cause (49.1 vs. 46.4; P < .001) and diabetes-related (16.9 vs. 14.6; P < .001) prescriptions at the 1-year follow-up.
Overall, all-cause and diabetes-related health care costs were similar between the two groups after 1 year. The sitagliptin cohort had 21% higher costs for office visits ($2,023 vs. $1,684; P = .01) and 29% higher costs for outpatient visits ($4,179 vs. $3,239; P = .003). However, these higher office visit costs were offset by the higher pharmacy costs among the dapagliflozin cohort ($7,295 vs. $6,749; P = .006). For diabetes-related health care costs, the sitagliptin cohort had 11.1% higher office visit costs ($658 vs. $592; P = .034), whereas the dapagliflozin cohort had 18.4% higher pharmacy costs ($4,830 vs. $4,081; P < .001).
The researchers conducted a subgroup analysis of 1,804 patients (902 in each cohort) who were prescribed oral diabetes monotherapy at baseline (85% prescribed metformin). At follow-up, the sitagliptin subgroup had 17% higher total all-cause health care costs ($14,884 vs. $12,353; P = .026), including higher office visit costs ($2,078 vs. $1,323; P = .003). Total diabetes-related health care costs were similar between the two cohorts ($6,750 for dapagliflozin vs. $7,383; P = .399); however, diabetes-related office visits were higher among the sitagliptin subgroup ($542 vs. $458; P < .001), whereas diabetes-related pharmacy costs were higher among the dapagliflozin subgroup ($3,123 vs. $2,837; P = .015).
Because data have shown that higher health care utilization and costs are associated with poor glucose control, the researchers noted that patients prescribed dapagliflozin may have had better glucose control than those prescribed sitagliptin with fewer complications that required office visits. In addition, nearly all patients prescribed dapagliflozin used separate pill formulations rather than a fixed-dose combination pill, whereas 36% of those prescribed sitagliptin used fixed-dose combination therapy.
“The higher diabetes-related pharmacy fills and costs [with dapagliflozin] may reflect the difference in receipt of [fixed-dose combination] therapy between the two cohorts. Receipt of [fixed-dose combination] therapy has been found to be associated with lower diabetes-related costs,” the researchers wrote.
“In the appropriate patient, the findings of this study should factor into decision-making when selecting the class of oral agent to intensify with in patients inadequately controlled with metformin or another oral agent monotherapy,” Frias said – by Tina DiMarcantonio-Brown
For more information:
Juan Pablo Frias, MD, FACE, can be reached at National Research Institute, 2010 Wilshire Blvd. #302, Los Angeles, CA 90057; email: juan.frias@nritrials.com.
Disclosure: Frias reports he receives research support from AstraZeneca and Merck, and is a consultant for AstraZeneca and Merck.