PMID- 33992426
OWN - NLM
STAT- MEDLINE
DCOM- 20220503
LR  - 20220503
IS  - 1535-6280 (Electronic)
IS  - 0146-2806 (Linking)
VI  - 47
IP  - 6
DP  - 2022 Jun
TI  - First-line Treatment with Empagliflozin and Metformin Combination Versus Standard 
      Care for Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease in 
      Qatar. A Cost-Effectiveness Analysis.
PG  - 100852
LID - S0146-2806(21)00067-0 [pii]
LID - 10.1016/j.cpcardiol.2021.100852 [doi]
AB  - Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown to reduce 
      cardiovascular events and mortality in patients with type 2 diabetes mellitus 
      (T2DM), but they are currently not used as first-line therapy in clinical 
      practice. This study sought to evaluate the cost-effectiveness of first-line 
      empagliflozin plus standard care for patients with newly diagnosed T2DM and 
      existing cardiovascular disease (CVD). A decision-analytic Markov model with 
      one-year cycles and a lifetime time horizon was developed from the perspective of 
      the Qatari healthcare system to compare first-line empagliflozin combined with 
      metformin versus metformin monotherapy for patients aged 50 to 79 years with T2DM 
      and existing CVD. Two health states were considered: 'Alive with CVD and T2DM' 
      and 'Dead'. Patients could experience non-fatal myocardial infarction, non-fatal 
      stroke, hospitalization for heart failure, hospitalization for unstable angina, 
      and cardiovascular or non-cardiovascular death. Model inputs were ascertained 
      from published and publicly available sources in Qatar. Costs and outcomes were 
      discounted at 3% per annum. Sensitivity analyses were conducted to evaluate 
      parameter uncertainty. The model predicted that adding empagliflozin to current 
      standard care led to additional 1.9 years of life saved (YoLS) and 1.5 
      quality-adjusted life year (QALYs) per person, and an incremental cost of QAR 
      56,869 (USD 15,619), which equated to an incremental cost-effectiveness ratio of 
      QAR 30,675 (USD 8,425) per YoLS and QAR 39,245 (USD 10,779) per QALY. Sensitivity 
      analyses showed the findings to be robust. First-line empagliflozin combined with 
      metformin appears to be a cost-effective therapeutic option for patients with 
      T2DM and CVD.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Abushanab, Dina
AU  - Abushanab D
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia; Drug Information Department, Hamad Medical Corporation, Doha, Qatar.
FAU - Al-Badriyeh, Daoud
AU  - Al-Badriyeh D
AD  - College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
FAU - Liew, Danny
AU  - Liew D
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Ademi, Zanfina
AU  - Ademi Z
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia. Electronic address: zanfina.ademi@monash.edu.
LA  - eng
PT  - Journal Article
DEP - 20210406
PL  - Netherlands
TA  - Curr Probl Cardiol
JT  - Current problems in cardiology
JID - 7701802
RN  - 0 (Benzhydryl Compounds)
RN  - 0 (Glucosides)
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
RN  - HDC1R2M35U (empagliflozin)
SB  - IM
MH  - Benzhydryl Compounds
MH  - *Cardiovascular Diseases/epidemiology/etiology/prevention & control
MH  - Cost-Benefit Analysis
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy/epidemiology
MH  - Glucosides
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - *Metformin/therapeutic use
MH  - Qatar/epidemiology
EDAT- 2021/05/17 06:00
MHDA- 2022/05/04 06:00
CRDT- 2021/05/16 20:29
PHST- 2021/03/25 00:00 [received]
PHST- 2021/03/27 00:00 [accepted]
PHST- 2021/05/17 06:00 [pubmed]
PHST- 2022/05/04 06:00 [medline]
PHST- 2021/05/16 20:29 [entrez]
AID - S0146-2806(21)00067-0 [pii]
AID - 10.1016/j.cpcardiol.2021.100852 [doi]
PST - ppublish
SO  - Curr Probl Cardiol. 2022 Jun;47(6):100852. doi: 10.1016/j.cpcardiol.2021.100852. 
      Epub 2021 Apr 6.