SHORT-TERM ECONOMIC AND CLINICAL OUTCOMES OF CANAGLIFLOZIN COMPARED TO SITAGLIPTIN IN THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS

Wednesday, October 23, 2013
Key Ballroom Foyer (Hilton Baltimore)
Poster Board # P4-21
Applied Health Economics (AHE)

Varun U. Ektare1, Janice MS Lopez2, Silas Martin2, Dipen Patel1, Marcia F.T. Rupnow2 and Marc Botteman1, (1)Pharmerit International, Bethesda, MD, (2)Janssen Scientific Affairs, LLC, Raritan, NJ
Purpose:

Evaluate the short-term economic outcomes of treating T2DM with canagliflozin v. sitagliptin (combined with metformin and a sulfonylurea) to achieve clinical goals from a managed care perspective.

Method: The one-year economic impact of using canagliflozin v. sitagliptin was estimated using a program that combined clinical outcomes and cost data. Data on efficacy and key adverse events (AEs) were obtained from a comparative trial of canagliflozin 300mg/day versus sitagliptin 100mg/day. Based on a claims database analysis, achieving (vs. not achieving) HbA1C<7% was assumed to result in $3,055/year and $1,651/year in total and diabetes-related savings. Based on literature, a 1% decrease in weight was associated with $288/year saved. AE-related costs (i.e., $105-$154/genital mycotic infections and $532/hypoglycemia requiring third-party assistance) were derived from treatment algorithms, literature, and reimbursement rates. Drug costs were literature-based. Total costs, average and incremental costs/key outcomes were calculated.

Result: Canagliflozin resulted in net savings of $581 compared to sitagliptin.  Savings remained when sensitivity analyses were conducted. The average and incremental cost/key outcome favored canagliflozin.

Key Inputs/Results

 

Canagliflozin

Sitagliptin

Difference

(Canagliflozin – Sitagliptin)

Clinical Inputs / Outcomes

 

 

 

% achieving HbA1C < 7% at week 52

47.6%

35.3%

+12.3%

Absolute HbA1C reduction (%) from baseline

1.03%

0.66%

0.37%

% without treatment failure

89.40%

77.50%

+11.90%

% without severe hypoglycemic event

96.00%

96.60%

-0.60%

% weight change from baseline

-2.5%

+0.3%

-2.8%

%  balanoposthitis (males)

9.2%

0.5%

+8.7%

%  vulvovaginal candidiasis (females)

15.3%

4.3%

+11%

%  urinary tract infections

4.0%

5.6%

-1.6%

Costs

 

 

 

Drug-related costs

$3,418

$3,210

$207

Non-drug costs

$17,417

$18,206

-$788

Weight-related (change from baseline)

-$470

$56

-$527

Total medical

  $17,831

$18,120

-$289

AEs (infections + hypoglycemic events)

$57

$30

$27

Total Cost

$20,835

$21,416

-$581

Cost per Key Outcome

 

 

 

Cost/patient achieving HbA1C <7%  (week 52)

$43,772(a)

$60,669(a)

Canagliflozin dominates(b)

Cost/1% change  HbA1c

$20,228(a)

$32,449(a)

Canagliflozin dominates(b)

Cost/patient without treatment failure

$23,306(a)

$27,634(a)

Canagliflozin dominates(b)

Cost/patient without severe hypoglycemia event

$21,703(a)

$22,170(a)

Sitagliptin costs $96,833/patient without severe hypoglycemic event(c)

(a)Within-treatment

(b)Incremental cost/difference; Canagliflozin less expensive/more efficacious (HbA1C, weight) than sitagliptin.

(c)Incremental cost/difference; Sitagliptin more expensive and efficacious (marginally lower incidence severe hypoglycemia) than canagliflozin.

Conclusion:

This 52-week economic analysis suggests canagliflozin results in lower costs than sitagliptin. Cost per patient achieving HbA1C<7% metrics may provide additional insights in new therapy evaluations.