(148) Health Care Utilization and Medical Costs in New Users of Once-weekly GLP-1 RAs Compared with New Users of DPP-4is Among Individuals with Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

Publication Number: 809

Background: The treatment of people with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) is associated with significant economic burden. Guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which have verified cardiovascular benefits in this population. However, evidence demonstrating reductions in health care resource utilization (HCRU) and medical costs in people with T2D and ASCVD using GLP-1 RAs remains limited.

Objectives: To compare ASCVD-related and all-cause HCRU and medical costs in new users of once-weekly (OW) GLP-1 RAs vs new users of dipeptidyl peptidase 4 inhibitors (DPP-4is) who have T2D and ASCVD.

Methods: This retrospective cohort study, which spanned from January 1, 2017, to September 30, 2021, analyzed data obtained from the Optum Clinformatics® Data Mart. Adults with continuous use of the index drug (OW GLP-1 RA or DPP-4i) for ≥90 days, continuous enrollment, confirmed diagnosis of T2D, and observed history of ASCVD were included. Patients were excluded due to use of the index or comparison drug at baseline, type 1 diabetes, or pregnancy. Patients were followed until the earliest of death, enrollment end, index drug discontinuation, initiation of the comparison drug or a sodium-glucose cotransporter-2 inhibitor, or study end. We evaluated all-cause and ASCVD-related inpatient (IP) and total medical costs (per person per month [PPPM]); IP, outpatient (OP), and emergency room (ER) visits; and IP days (per 1000 person-months). Generalized linear models with inverse probability of treatment weighting were used to generate rate ratios (RR) for comparison.

Results: Users of OW GLP-1 RAs (weighted N=25,287) had 25% lower ASCVD-related IP costs ($341.26 vs $452.69 PPPM; RR=0.75 [95% CI, 0.68-0.84]), 19% lower ASCVD-related medical costs ($596.72 vs $738.11 PPPM; RR=0.81 [0.74-0.88]), 26% lower all-cause IP costs ($789.36 vs $1068.22 PPPM; RR=0.74 [0.69-0.79]), and 23% lower all-cause medical costs ($2186.36 vs $2824.10 PPPM; RR=0.77 [0.74-0.81]) compared with users of DPP-4is (weighted N=39,684; all P< 0.01). Users of OW GLP-1 RAs had 23% fewer ASCVD-related IP visits (RR=0.77 [0.71-0.84]) and 13% fewer ASCVD-related OP visits (0.87 [0.82-0.92]) compared with users of DPP-4is (all P< 0.01). Finally, users of OW GLP-1 RAs had significantly fewer all-cause ER visits (0.92 [0.87-0.97]), IP visits (0.73 [0.69-0.77]), OP visits (0.92 [0.89-0.94]), and IP days (0.83 [0.71-0.96]) compared with users of DPP-4is (all P< 0.05).

Conclusions: This study suggests that OW GLP-1 RAs are associated with significant reductions in ASCVD-related IP and OP visits; all-cause IP, OP, and ER visits; and ASCVD-related and all-cause IP costs and total medical costs compared with DPP-4is in people with T2D and ASCVD.