First-line SGLT2 inhibitors, GLP1 receptor agonists need to cut price to be cost-effective

First-line treatment with sodium–glucose cotransporter-2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP1) receptor agonists improves outcomes in patients with type 2 diabetes (T2D), but to be cost-effective, the prices of these drugs must drop by at least 70 percent, suggests a study.

A team of investigators conducted this study using the individual-level Monte Carlo-based Markov model. They obtained data from randomized trials, Centers for Disease Control and Prevention databases, RED BOOK, and the National Health and Nutrition Examination Survey.

Drug-naïve T2D patients in the US who received first-line SGLT2 inhibitors or GLP1 receptor agonists were included in the assessment. The investigators then measured the following outcomes: life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs).

Compared with metformin, first-line SGLT2 inhibitors and GLP1 receptor agonists resulted in lower lifetime rates of congestive heart failure, ischaemic heart disease, myocardial infarction, and stroke. First-line treatment with SGLT2 inhibitors cost $43,000 more and added 1.8 quality-adjusted months when compared with metformin ($478,000 per quality-adjusted life-year [QALY]).

On the other hand, first-line injectable GLP1 receptor agonists cost more but reduced QALYs relative to metformin.

Sensitivity analysis revealed that first-line GLP1 receptor agonists were no longer dominated when injection disutility was removed (ICER, $327,000 per QALY). Oral GLP1 receptor agonists, however, were not economical (ICER, $823,000 per QALY).

To be cost-effective at under $150,000 per QALY, SGLT2 inhibitors would need to be priced at under $5 per day and oral GLP1 receptor agonists at under $6 per day.

“Guidelines recommend SGLT2 inhibitors and GLP1 receptor agonists as second-line therapy for patients with T2D. Expanding their use as first-line therapy has been proposed, but the clinical benefits may not outweigh their costs,” the investigators said.