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

Xinyu Li (), Rudolf Hoogenveen, Mohamed El Alili, Saskia Knies, Junfeng Wang, Joline W. J. Beulens, Petra J. M. Elders, Giel Nijpels, Anoukh Giessen and Talitha L. Feenstra
Additional contact information
Xinyu Li: University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy
Rudolf Hoogenveen: National Institute for Public Health and the Environment
Mohamed El Alili: Vrije Universiteit Amsterdam
Saskia Knies: Zorginstituut Nederland
Junfeng Wang: Utrecht University
Joline W. J. Beulens: Location Vrije Universiteit
Petra J. M. Elders: Amsterdam Cardiovascular Sciences
Giel Nijpels: Amsterdam Cardiovascular Sciences
Anoukh Giessen: National Institute for Public Health and the Environment
Talitha L. Feenstra: University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy

PharmacoEconomics, 2023, vol. 41, issue 10, No 6, 1249-1262

Abstract: Abstract 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 (

Date: 2023
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DOI: 10.1007/s40273-023-01286-3

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