PMID- 36864575
OWN - NLM
STAT- MEDLINE
DCOM- 20230605
LR  - 20230606
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 25
IP  - 7
DP  - 2023 Jul
TI  - Estimating the value of sodium-glucose cotransporter-2 inhibitors within the 
      context of contemporary guidelines and the totality of evidence.
PG  - 1830-1838
LID - 10.1111/dom.15040 [doi]
AB  - AIMS: To comprehensively estimate the cost-effectiveness of sodium glucose 
      cotransporter-2 (SGLT2) inhibitor usage in the management of type 2 diabetes 
      mellitus (T2DM) at established clinical review points, incorporating the totality 
      of proven health benefits. MATERIALS AND METHODS: This study considered the 
      cardio- and reno-protective effects of SGLT2 inhibitors using the Cardiff type 2 
      diabetes model. Conventional cost-effectiveness evaluations were undertaken for 
      eligible populations at relevant intensification points reflecting the 2022 
      guidelines versus the 2015 National Institute of Health and Care Excellence 
      (NICE) guidelines; incremental cost-effectiveness ratio lifetime trajectories and 
      timepoints for complete cost-offset were estimated for each pathway. Treatment 
      effects, utility decrements and costs (applied additively and discounted at 3.5%) 
      were sourced from the published literature. RESULTS: For all subpopulations on 
      treatment pathways reflecting the NG28-2022 guidelines, SGLT2 inhibitor 
      introduction was cost-effective, becoming cost-saving between 2 and 16 years 
      post-initiation. Despite increases in pharmacy costs, predicted lifetime costs 
      were lower than for pathways reflecting the NG28-2015 guidelines, driven by a 
      reduction in heart failure hospitalization and chronic kidney disease costs. 
      Incremental gains in quality-adjusted life years (ranging from 0.58-1.12) 
      resulted in dominance for the updated NG28-2022 guidance in all scenarios. 
      CONCLUSIONS: Our results show that SGLT2 inhibitors have the potential to lower 
      healthcare costs while improving health outcomes in eligible patient 
      subpopulations.
CI  - (c) 2023 AstraZeneca. Diabetes, Obesity and Metabolism published by John Wiley & 
      Sons Ltd.
FAU - McEwan, Phil
AU  - McEwan P
AUID- ORCID: 0000-0001-7488-9058
AD  - Health Economics and Outcomes Research Ltd, Cardiff, UK.
FAU - Foos, Volker
AU  - Foos V
AD  - Health Economics and Outcomes Research Ltd, Cardiff, UK.
FAU - Martin, Becky
AU  - Martin B
AD  - AstraZeneca UK Ltd, London, UK.
FAU - Chen, Jieling
AU  - Chen J
AD  - AstraZeneca R&D Pharmaceuticals, Gaithersburg, Maryland, USA.
FAU - Evans, Marc
AU  - Evans M
AUID- ORCID: 0000-0003-0671-0778
AD  - Diabetes Resource Centre, University Hospital Llandough, Cardiff, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230329
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - IY9XDZ35W2 (Glucose)
RN  - 9NEZ333N27 (Sodium)
SB  - IM
MH  - Humans
MH  - *Diabetes Mellitus, Type 2/metabolism
MH  - Hypoglycemic Agents/therapeutic use
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Glucose/therapeutic use
MH  - Sodium
EDAT- 2023/03/03 06:00
MHDA- 2023/06/05 06:42
CRDT- 2023/03/02 23:52
PHST- 2023/02/16 00:00 [revised]
PHST- 2023/01/18 00:00 [received]
PHST- 2023/02/27 00:00 [accepted]
PHST- 2023/06/05 06:42 [medline]
PHST- 2023/03/03 06:00 [pubmed]
PHST- 2023/03/02 23:52 [entrez]
AID - 10.1111/dom.15040 [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2023 Jul;25(7):1830-1838. doi: 10.1111/dom.15040. Epub 2023 
      Mar 29.