Humana Healthcare Research, Inc., Louisville, KY, United States.
Humana Healthcare Research, Inc., Louisville, KY, United States.
Diabetes Res Clin Pract. 2021 May;175:108800. doi: 10.1016/j.diabres.2021.108800. Epub 2021 May 4.
To compare SGLT2 inhibitors and GLP-1 agonists on cardiovascular (CV) outcomes, treatment persistence/discontinuation, healthcare utilization and costs.
This retrospective cohort study utilized medical and pharmacy claims to identify new SGLT2 inhibitor or GLP-1 agonist users from January 2015 to June 2017. A total of 5,507 patients were included in each treatment group after 1:1 propensity score matching. Cox proportional hazards models were used to compare CV outcomes and treatment discontinuation. Healthcare utilization and costs were compared using Wilcoxon signed rank test.
No differences in the primary composite CV outcome or secondary CV outcome were observed. Patients using GLP-1 agonists were more likely to discontinue treatment (hazard ratio 1.15, 95% confidence interval 1.10-1.21) and more likely to have an inpatient hospitalization (14.4% vs. 11.9%, P < 0.001) or emergency department visit (27.4% vs. 23.5%, P < 0.001) compared to patients on SGLT2 inhibitors. The average per-person per-month cost difference was +$179 for total cost (P < 0.001), +$70 for medical cost (P < 0.001) and +$108 for pharmacy cost (P < 0.001) for GLP-1 agonists compared to SGLT2 inhibitors.
Differences in composite CV outcomes were not established. However, other findings that favored SGLT2 inhibitors should be weighed against the known risks associated with this therapeutic class.
比较 SGLT2 抑制剂和 GLP-1 激动剂在心血管（CV）结局、治疗持续/中断、医疗保健利用和成本方面的差异。
本回顾性队列研究利用医疗和药房理赔数据，从 2015 年 1 月至 2017 年 6 月确定新的 SGLT2 抑制剂或 GLP-1 激动剂使用者。在 1:1 倾向评分匹配后，每组各有 5507 名患者纳入研究。使用 Cox 比例风险模型比较 CV 结局和治疗中断情况。采用 Wilcoxon 符号秩检验比较医疗保健利用和成本。
主要复合 CV 结局或次要 CV 结局无差异。使用 GLP-1 激动剂的患者更有可能中断治疗（风险比 1.15，95%置信区间 1.10-1.21），更有可能住院（14.4%比 11.9%，P<0.001）或急诊就诊（27.4%比 23.5%，P<0.001）。与 SGLT2 抑制剂相比，GLP-1 激动剂的人均每月成本差异为总费用增加$179（P<0.001），医疗费用增加$70（P<0.001），药房费用增加$108（P<0.001）。
未确定复合 CV 结局的差异。然而，应该权衡 SGLT2 抑制剂的其他有利发现，以应对该治疗类别相关的已知风险。
