Abstract 168: A Real-World Claims Analysis of Costs Among Patients With Type 2 Diabetes Mellitus and Cardiovascular Disease Receiving Empagliflozin or Other Antihyperglycemic Agents
Authors: Raju Aditya , Pimple Pratik , Stafkey-Mailey Dana , Farrelly Eileen , Shetty Sharash 
Published: April 2019

Background:
Cardiovascular disease (CVD) is a major complication and the leading cause of death associated with type 2 diabetes (T2D). People with T2D are 2 to 4 times more likely to develop CVD than those without T2D. Empagliflozin, a novel SGLT-2 inhibitor, has demonstrated beneficial clinical effects on cardiovascular outcomes in both RCTs and real-world studies. The objective of this study was to evaluate total healthcare costs in patients initiating empagliflozin compared to other antihyperglycemic agents (AHAs; DPP-4 inhibitors, other SGLT-2 inhibitors [excluding empagliflozin], GLP-1 agonists, or insulin) in T2D patients with CVD.

Methods:
A retrospective cohort study was conducted using a US-based, commercial administrative claims database. Patients who were newly initiated on either empagliflozin or other AHAs between 08/01/2014-12/31/2016 were eligible for inclusion in the study as either an empagliflozin cohort or other AHAs cohort. The index date was the date of the first prescription for empagliflozin or other AHA. A 1-year pre-index period was used to identify patients with both CVD and T2D diagnosis and to assess covariates of interest. Patients were excluded if they had a claim for empagliflozin or other AHA during the pre-index period. All outcomes were assessed during a post-index period of up to 1 year. All-cause (AC) costs were computed on a per-patient-per-month (PPPM) basis and evaluated using generalized linear models, controlling for differences in pre-index characteristics between the 2 cohorts.

Results:
A total of 13,563 T2D patients with CVD met the study criteria (empagliflozin=441; other AHAs=13,122). The mean age±SD was 58±9 years, 69% were male, and atherosclerosis was the most common CVD. Compared to the other AHAs, patients in the empagliflozin cohort were younger and had fewer hospitalizations and lower AC costs in the pre-index period but were more likely to use other AHAs or CVD-related drugs and have dyslipidemia in the pre-index period. During the post-index period, unadjusted total PPPM AC costs were significantly lower for the empagliflozin cohort vs other AHAs ($1,690 vs $2,489;
P
<0.001). After covariate adjustment, the adjusted total AC cost difference ($412 PPPM [$2,057 vs $2,469]) remained significantly lower for the empagliflozin cohort (
P
<0.001). The adjusted cost differences were mainly driven by lower AC medical costs for the empagliflozin cohort (cost difference: $400;
P
≤0.001), as no significant difference in AC pharmacy costs were observed (cost difference: $31;
P
=0.554).

Conclusions:
In this study, patients diagnosed with T2D and CVD had lower all-cause costs following treatment initiation with empagliflozin compared to other AHAs. This finding can provide critical insight for healthcare decision makers tasked with reducing the clinical and economic burden associated with CVD among patients with T2D during therapy selection.