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10-04-2022 | Healthcare costs | News

First-line SGLT2 inhibitors, GLP-1 receptor agonists ‘not cost effective’

Author: Eleanor McDermid


medwireNews: The authors of a modeling study say that the price of sodium-glucose cotransporter (SGLT)2 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists would need to fall “by at least 70%” for them to be cost effective as first-line treatments in the USA.

The “major driving factors” underlying the poor cost effectiveness of these medications in the first line relative to metformin were “their high costs and a decrease in quality of life associated with injections,” say Neda Laiteerapong (University of Chicago, Illinois, USA) and co-researchers.

As reported in the Annals of Internal Medicine, the investigators based their model on the UKPDS Outcomes Model version 2, modified to incorporate the effects of SGLT2 inhibitors and GLP-1 receptor agonists on glucose control as well as factors such as blood pressure, weight, and cardiovascular risk.

They applied the model to 493 people with type 2 diabetes who were eligible for first-line glucose-lowering medication, identified in NHANES 2013–2016. These people were an average age of 55 years, with diabetes diagnosed an average of 4.2 years previously. Fifty percent were women and 36% had diabetic complications.

The model revealed an absolute reduction in the lifetime rate of macrovascular complications of 4.4% with SGLT2 inhibitors and 5.2% with GLP-1 receptor agonists used first-line, compared with metformin, but only a marginal (0.1%) reduction in the incidence of microvascular outcomes.

Moreover, first-line use of these medications resulted in increased undiscounted life expectancy, by 3.0 and 3.4 months for SGLT2 inhibitors and GLP-1 receptor agonists, respectively, versus metformin.

However, while first-line SGLT2 inhibitor use increased discounted quality-adjusted life expectancy by 33 days, GLP-1 receptor agonist use reduced it by 22 days, because of the need to inject these medications.

The researchers calculated that first-line SGLT2 inhibitors would be cost effective at a price of US$ 1800 (€ 1834) per year ($ 5/€ 5.1 per day), based on a willingness-to-pay threshold of less than $ 150,000 (€ 152,831) per quality-adjusted life–year. And oral GLP-1 receptor agonists would become cost effective at a price of $ 2100 (€ 2140) per year ($ 6/€ 6.1 per day).

This would require price reductions of at least 70% for SGLT2 inhibitors and 90% for oral GLP-1 receptor agonists, say Laiteerapong and team.

They note that even an already available generic version of an older GLP-1 receptor agonist is relatively expensive, and that “it may take decades for medication prices to drop low enough to become affordable.”

They conclude: “Without external incentives, limited access to these drug classes will likely persist […] as will further diabetes disparities—for decades into the future—because of differential access to care due to insurance (for example, private vs. public), which often tracks race and ethnicity.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Ann Intern Med 2022; doi:10.7326/M21-2941


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