Costs Associated with Healthcare Resources Utilization Among Empagliflozin vs GLP-1RA Initiators in Routine Clinical Care in Denmark

Background: The sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin has shown reductions in major adverse cardiac events (MACE) similar to glucagon-like peptide-1 receptor agonists (GLP-1RAs) in routine care in Denmark. There is limited evidence how these therapies compare regarding overall costs associated with healthcare resources utilization.

Objectives: To assess the total average healthcare costs per patient after drug initiation with empagliflozin versus GLP-1RAs in Denmark.

Methods: Nationwide population-based comparative cohort study based on linked prospective healthcare databases for the entire population in Denmark (current population 5.8 million) during Jan 1, 2015, and to Dec 31, 2018. We included 13,249 new users of empagliflozin and 13,747 new users of GLP-1RAs. Propensity scores were applied to balance potential confounders across the two treatment groups through inverse probability treatment weighting (IPTW). We assessed total average costs per year associated with all healthcare resource utilization (inpatient, emergency room, and outpatient clinic hospital care, primary care health services, and prescription medications costs at pharmacies) among drug initiators while on-treatment (i.e., while covered by filled drug prescriptions including a grace period of 60 days).

Results: The two IPTW cohorts were well-balanced at baseline (median age 61 years, 60% men, diabetes duration of 6.7 years, 19% with pre-existing ischemic heart disease, 8% with history of cerebrovascular disease). Healthcare costs in the year prior to drug initiation were also well-balanced. Mean follow-up on-treatment after initiation was 11.3 months (SD 9.8 months) in empagliflozin vs 12.3 (SD 10.9) months in GLP-1 RA initiators, with a total of 12,657 years of drug exposure with empagliflozin and 13,554 years with GLP-1RAs. Average costs per patient per year were very similar in empagliflozin and GLP-1 RA initiators regarding inpatient hospitalizations (13,565 DKK versus 13,275 DKK), hospital outpatient clinic visits (12,007 DKK versus 12,152 DKK), emergency room visits (370 DKK versus 399 DKK), and primary care services (4,108 DKK versus 4,302 DKK). Total costs of any prescription drugs were lower in empagliflozin initiators (8,946 DKK versus 14,029 DKK). Total healthcare costs on-treatment were lower in empagliflozin initiators at 38,995 DKK per person-year than in GLP-1RA initiators at 44,157 DKK per person-year, respectively.

Conclusions: In this nationwide population-based study, average healthcare costs after drug initiation and while on treatment were lower for empagliflozin than GLP-1RAs initiators, driven by lower costs of prescription drugs.