Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden and Capio S:t Görans Hospital, Stockholm, Sweden.
AstraZeneca Europe & Canada, Oslo, Norway.
Diabetes Obes Metab. 2019 Dec;21(12):2651-2659. doi: 10.1111/dom.13852. Epub 2019 Aug 26.
To investigate how the cardiovascular (CV) risk benefits of dapagliflozin translate into healthcare costs compared with other non-sodium-glucose cotransporter-2 inhibitor glucose-lowering drugs (oGLDs) in a real-world population with type 2 diabetes (T2D) that is similar to the population of the DECLARE-TIMI 58 trial.
Patients initiating dapagliflozin or oGLDs between 2013 and 2016 in Swedish nationwide healthcare registries were included if they fulfilled inclusion and exclusion criteria of the DECLARE-TIMI 58 trial (DECLARE-like population). Propensity scores for the likelihood of dapagliflozin initiation were calculated, followed by 1:3 matching with initiators of oGLDs. Per-patient cumulative costs for hospital healthcare (in- and outpatient) and for drugs were calculated from new initiation until end of follow-up.
A total of 24 828 patients initiated a new GLD; 6207 initiated dapagliflozin and 18 621 initiated an oGLD. After matching based on 96 clinical and healthcare cost variables, groups were balanced at baseline. Mean cumulative 30-month healthcare cost per patient was similar in the dapagliflozin and oGLD groups ($11 807 and $11 906, respectively; difference, -$99; 95% CI, -$629, $483; P = 0.644). Initiation of dapagliflozin rather than an oGLD was associated with significantly lower hospital costs (-$658; 95% CI, -$1169, -$108; P = 0.024) and significantly higher drug costs ($559; 95% CI, $471, $648; P < 0.001). Hospital cost difference was related mainly to fewer CV- and T2D-associated complications with use of dapagliflozin compared with use of an oGLD (-$363; 95% CI, -$665, -$61; P = 0.008).
In a nationwide, real-world, DECLARE-like population, dapagliflozin was associated with lower hospital costs compared with an oGLD, mainly as a result of reduced rates of CV- and T2D-associated complications.
在与 DECLARE-TIMI 58 试验人群相似的 2 型糖尿病（T2D）真实世界人群中，评估达格列净相对于其他非钠-葡萄糖共转运蛋白 2 抑制剂类降糖药物（oGLD）的心血管（CV）风险获益如何转化为医疗保健成本。
纳入 2013 年至 2016 年期间在瑞典全国性医疗保健登记处开始使用达格列净或 oGLD 的患者，如果他们符合 DECLARE-TIMI 58 试验的纳入和排除标准（类似 DECLARE 人群）。计算达格列净起始可能性的倾向评分，然后与 oGLD 起始者进行 1:3 匹配。从新起始到随访结束，计算每位患者的累计住院医疗保健（门诊和住院）和药物费用。
共纳入 24828 例新开始使用 GLD 的患者；6207 例起始达格列净，18621 例起始 oGLD。基于 96 项临床和医疗保健费用变量进行匹配后，两组在基线时达到平衡。达格列净组和 oGLD 组的患者在 30 个月的累计医疗保健成本相似（分别为 11807 美元和 11906 美元，差异为-99 美元；95%CI，-629 美元，483 美元；P=0.644）。起始使用达格列净而非 oGLD 与医院费用显著降低相关（-658 美元；95%CI，-1169 美元，-108 美元；P=0.024），与药物费用显著升高相关（559 美元；95%CI，471 美元，648 美元；P<0.001）。医院成本差异主要与使用达格列净较使用 oGLD 相比，CV 和 T2D 相关并发症的发生率较低有关（-363 美元；95%CI，-665 美元，-61 美元；P=0.008）。
在全国范围内，基于真实世界的类似 DECLARE 人群，与 oGLD 相比，达格列净与较低的医院费用相关，主要是由于 CV 和 T2D 相关并发症发生率降低所致。
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