Cost-Effectiveness of SGLT2 Inhibitors in a Real-World Population: A MICADO Model-Based Analysis Using Routine Data from a GP Registry.

Autor: Li X; University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands. li.xinyu@rug.nl., Hoogenveen R; Expertise Center for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands., El Alili M; Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Zorginstituut Nederland, Diemen, The Netherlands., Knies S; Zorginstituut Nederland, Diemen, The Netherlands.; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Wang J; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands., Beulens JWJ; Department of Epidemiology and Data Sciences, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam, The Netherlands.; Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Elders PJM; Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.; Department of General Practice, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam, The Netherlands., Nijpels G; Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., van Giessen A; Expertise Center for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands., Feenstra TL; University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.; Center for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Jazyk: angličtina
Zdroj: PharmacoEconomics [Pharmacoeconomics] 2023 Oct; Vol. 41 (10), pp. 1249-1262. Date of Electronic Publication: 2023 Jun 10.
DOI: 10.1007/s40273-023-01286-3
Abstrakt: Objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to reduce the risk of cardiovascular complications, which largely drive diabetes' health and economic burdens. Trial results indicated that SGLT2i are cost effective. However, these findings may not be generalizable to the real-world target population. This study aims to evaluate the cost effectiveness of SGLT2i in a routine care type 2 diabetes population that meets Dutch reimbursement criteria using the MICADO model.
Methods: Individuals from the Hoorn Diabetes Care System cohort (N = 15,392) were filtered to satisfy trial inclusion criteria (including EMPA-REG, CANVAS, and DECLARE-TIMI58) or satisfy the current Dutch reimbursement criteria for SGLT2i. We validated a health economic model (MICADO) by comparing simulated and observed outcomes regarding the relative risks of events in the intervention and comparator arm from three trials, and used the validated model to evaluate the long-term health outcomes using the filtered cohorts' baseline characteristics and treatment effects from trials and a review of observational studies. The incremental cost-effectiveness ratio (ICER) of SGLT2i, compared with care-as-usual, was assessed from a third-party payer perspective, measured in euros (2021 price level), using a discount rate of 4% for costs and 1.5% for effects.
Results: From Dutch individuals with diabetes in routine care, 15.8% qualify for the current Dutch reimbursement criteria for SGLT2i. Their characteristics were significantly different (lower HbA1c, higher age, and generally more preexisting complications) than trial populations. After validating the MICADO model, we found that lifetime ICERs of SGLT2i, when compared with usual care, were favorable (< €20,000/QALY) for all filtered cohorts, resulting in an ICER of €5440/QALY using trial-based treatment effect estimates in reimbursed population. Several pragmatic scenarios were tested, the ICERs remained favorable.
Conclusions: Although the Dutch reimbursement indications led to a target group that deviates from trial populations, SGLT2i are likely to be cost effective when compared with usual care.
(© 2023. The Author(s).)
Databáze: MEDLINE
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