Cost-Effectiveness of Empagliflozin In Patients With Type 2 Diabetes Mellitus At High Cardiovascular Risk In Poland

• Published in: Value in health Vol. 20; no. 9; p. A478
• Main Authors: Pawlik, D, Wójcik, R, Zawodnik, A, Kaczor, MP
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.10.2017
• Subjects: Autoimmune diseases; Cardiovascular disease; Cardiovascular diseases; Cost analysis; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Health care expenditures; Health economics; High risk; Patients; Quality adjusted life years; Robustness; Sensitivity analysis; Stochastic models; Stochasticity; Survival; Type 2 diabetes mellitus; Uncertainty; Poland
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.453

OBJECTIVES: To assess the cost-effectiveness of empagliflozin 10mg as an addon to standard care (SoC) in Polish patients with Type 2 Diabetes (T2D) at high risk for cardiovascular events (CV). METHODS: An existing health economic, stochastic model was used to simulate individual profiles of patients treated with empagliflozin lOmg added to SoC versus patients treated with SoC only, over a lifetime horizon. Modelling of diabetes-related events was implemented using a risk equations derived from the EMPA-REG OUTCOME™ study patient-level data for 10 cardiovascular and renal events by fitting parametric survival functions. Model outcomes included annual and cumulative event rates, life years (LY) and quality-adjusted life-years (QALYs).TWo perspectives were adopted using cost data from Polish sources: the public healthcare payer (PP) and the public payer plus patient (PP+P) perspective. Simulated costs and outcomes were discounted at a 5.0% and 3.5% annual rate, respectively. Probabilistic (PSA) and deterministic (DSA) sensitivity analyses were conducted to address uncertainty and test the robustness of the model results. RESULTS: Adding empagliflozin lOmg to SoC resulted in longer survival (9.8 LY vs. 8.7 LY with SoC) and a QALY gain of 0.81 at an additional cost of PLN10895 (€2,522) (PP) and PLN17184 (€3,978) (PP+P) versus SoC only. The base-case incremental cost-utility ratio (ICUR) was PLN13440 (€3,111) per QALY from the healthcare payer perspective and PLN21198 (€4,907) per QALY from the payer plus patient perspective, which is well below the cost-effectiveness threshold in Poland (PLN130002(€30093)/QALY). Irrespective of the cost perspective chosen, empagliflozin was estimated to have a 100% probability of being cost-effective. Base-case results were shown to be robust across a range of model parameters, with empagliflozin remaining cost-effective in all DSA scenarios investigated. CONCLUSIONS: Empagliflozin lOmg represents a highly cost effective option for the treatment of T2D patients with high risk of CV events in Poland.