Background: Despite growing evidence on the clinical benefits of empagliflozin, a sodium-glucose cotransporter 2 inhibitor, its impact on healthcare resource utilization (HCRU) and cost in routine-care patients with type 2 diabetes (T2D) is unknown.
Objectives: To compare rates of HCRU and cost of care in Medicare enrollees initiating empagliflozin vs. dipeptidyl peptidase-4 inhibitor (DPP-4i).
Methods: Using the Medicare fee-for-service data (08/2014-09/2018) from the first four years of the Empagliflozin Comparative Effectiveness and Safety (EMPRISE) study, we identified new users of empagliflozin (EMPA) vs. dipeptidyl peptidase-4 inhibitors (DPP-4i) among older adults with T2D aged ≥65 years. Follow-up started from drug initiation until disenrollment, end of the study period, death, or drug discontinuation/switching. We compared rates of HCRU and per-member per-year (PMPY) total cost of care along with inpatient, outpatient, and pharmacy cost components between empagliflozin and DPP4i. We estimated rate ratios (RR) for HCRU outcomes using negative binomial models and PMPY cost differences using gamma models, overall and stratified by history of cardiovascular disease (CVD), after adjusting for 143 baseline covariates using 1:1 propensity score matching.
Results: We identified 23,335 matched pairs of empagliflozin and DPP-4i initiators who were balanced in all baseline characteristics. The mean age was 72 years, 54% were male, and 51% had a history of baseline CVD. Overall, HCRU rates were lower in empagliflozin vs. DPP-4i initiators: hospital days (RR=0.89; 95% CI: 0.82, 0.97), number of ED visits (RR=0.86; 0.82, 0.91), number of hospitalizations (RR=0.86; 0.79, 0.93) and number of office visits was more similar (RR=0.96; 0.95, 0.98). Inpatient cost (Difference = -$713 PMPY; -847, -579) and outpatient cost (-$198 PMPY; -272, -124) were lower among empagliflozin users, with a slightly lower total cost of care for empagliflozin vs. DPP4i (-$1,109 PMPY; -1,478, -739), although diabetes medication-related pharmacy spending was higher in the empagliflozin group. In the CVD subgroup, total cost of care was lower for empagliflozin initiators (-$2,005 PMPY; -2,451, -1,337), while the difference was more attenuated in the non-CVD subgroup (-$296 PMPY; -740, 148).
Conclusions: Among older adults with T2D, empagliflozin use was associated with reduced hospitalization and ED visits with lower total costs of care, including its care components across different healthcare settings compared to DPP-4i. Considering superior clinical benefits, empagliflozin use seems a cost-effective strategy compared to DPP-4i use in routine care.
