Zhang Weichen, Yu Meichen, Cheng Guohua
Department of Pharmacy, Jinan University, Guangzhou, China.
Front Pharmacol. 2024 Apr 17;15:1373314. doi: 10.3389/fphar.2024.1373314. eCollection 2024.
Dapagliflozin inhibits the sodium-glucose cotransporter protein 2 (SGLT-2), while sotagliflozin, belonging to a new class of dual-acting SGLT-1/SGLT-2 inhibitors, has garnered considerable attention due to its efficacy and safety. Both Dapagliflozin and sotagliflozin play a significant role in treating worsening heart failure in diabetes/nondiabetes patients with heart failure. Therefore, this article was to analyze and compare the cost per outcome of both drugs in preventing one event in patients diagnosed with diabetes-related heart failure.
The Cost Needed to Treat (CNT) was employed to calculate the cost of preventing one event, and the Number Needed to Treat (NNT) represents the anticipated number of patients requiring the intervention treatment to prevent a single adverse event, or the anticipated number of patients needing multiple treatments to achieve a beneficial outcome. The efficacy and safety data were obtained from the results of two published clinical trials, DAPA-HF and SOLOIST-WHF. Due to the temporal difference in the drugs' releases, we temporarily analyzed the price of dapagliflozin to calculate the price of sotagliflozin within the same timeframe. The secondary analyses aimed to assess the stability of the CNT study and minimize differences between the results of the RCT control and trial groups, employing one-way sensitivity analyses.
The final results revealed an annualized Number Needed to Treat (aNNT) of 4 (95% CI 3-7) for preventing one event with sotagliflozin, as opposed to 23 (95% CI 16-55) for dapagliflozin. We calculated dapagliflozin's cost per prevented event (CNT) to be $109,043 (95% CI $75,856-$260,755). The price of sotagliflozin was set below $27,260, providing a favorable advantage. Sensitivity analysis suggests that sotagliflozin may hold a cost advantage.
In this study, sotagliflozin was observed to exhibit a price advantage over dapagliflozin in preventing one events, cardiovascular mortality, or all-cause mortality in patients with diabetes.
达格列净可抑制钠-葡萄糖协同转运蛋白2（SGLT-2），而索格列净属于一类新型的双重作用SGLT-1/SGLT-2抑制剂，因其疗效和安全性而备受关注。达格列净和索格列净在治疗糖尿病/非糖尿病心力衰竭患者的心力衰竭恶化方面均发挥着重要作用。因此，本文旨在分析和比较这两种药物在预防糖尿病相关心力衰竭患者发生一次事件时的每结局成本。
采用治疗所需成本（CNT）来计算预防一次事件的成本，所需治疗人数（NNT）表示需要进行干预治疗以预防一次不良事件的预期患者人数，或需要多次治疗以实现有益结局的预期患者人数。疗效和安全性数据来自两项已发表的临床试验DAPA-HF和SOLOIST-WHF的结果。由于两种药物上市时间存在差异，我们临时分析了达格列净的价格以计算同一时间范围内索格列净的价格。次要分析旨在评估CNT研究的稳定性，并通过单向敏感性分析尽量减少随机对照试验对照组和试验组结果之间的差异。
最终结果显示，索格列净预防一次事件的年化所需治疗人数（aNNT）为4（95%CI 3-7），而达格列净为23（95%CI 16-55）。我们计算得出达格列净预防一次事件的成本（CNT）为109,043美元（95%CI 75,856美元-260,755美元）。索格列净的价格设定在27,260美元以下，具有明显优势。敏感性分析表明，索格列净可能具有成本优势。
在本研究中，观察到索格列净在预防糖尿病患者发生一次事件、心血管死亡率或全因死亡率方面比达格列净具有价格优势。
