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Healthcare Utilization and Cost Associated with Empagliflozin in Older Adults with Type 2 Diabetes

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posted on 2024-06-25, 18:30 authored by Phyo Than Htoo, Mehdi NajafZadeh, Helen Tesfaye, Sebastian Schneeweiss, Deborah J. Wexler, Robert J. Glynn, Niklas Schmedt, Anouk Déruaz-Luyet, Lisette Koeneman, Julie M. Paik, Elisabetta Patorno

Objective: We compared healthcare resource utilization (HCRU) and costs for inpatient and outpatient services and dispensed medications in older adults with type 2 diabetes initiating empagliflozin vs. dipeptidyl peptidase-4 inhibitor (DPP-4i).

Research Design and Methods: The study population included US Medicare fee-for-service beneficiaries with diabetes (≥65 years) initiating empagliflozin or DPP-4i (08/2014-09/2018). We estimated rate ratios (RR) for HCRU outcomes using zero-inflated negative binomial regression and per-member per-year (PMPY) cost differences using gamma regression, overall and stratified by baseline cardiovascular disease (CVD), after adjusting for 143 baseline covariates using 1:1 propensity score matching.

Results: We identified 23,335 matched pairs (mean age 72 years, 51% baseline CVD). HCRU rates were lower in empagliflozin vs. DPP-4i initiators: inpatient days (RR=0.89; 95% CI: 0.82, 0.97), number of emergency department (ED) visits (RR=0.86; 0.82, 0.91), number of hospitalizations (RR=0.86; 0.79, 0.93), and number of office visits (RR=0.96; 0.95, 0.98). Inpatient cost (-$713 PMPY; -847, -579), outpatient cost (-$198 PMPY; -272, -124), and total cost of care (-$1,109 PMPY; -1,478, -739) were lower for empagliflozin vs. DPP-4i, although diabetes medication cost was higher in empagliflozin initiators ($454 PMPY; 284, 567). In the CVD subgroup, total cost was lower for empagliflozin initiators (-$2,005 PMPY; -2,451, -1,337), while the difference was attenuated in the non-CVD subgroup (-$296 PMPY; -740, 148).

Conclusions: Among older adults with diabetes, empagliflozin was associated with lower inpatient days, number of hospitalizations, ED visits, and office visits, with lower costs of care compared to DPP-4i, especially in those with history of CVD.

Funding

Dr. Htoo is personally supported by a research grant (4-22-PDFPM-15, PI: Htoo) from the American Diabetes Association. Dr. Najafzadeh was supported by research grants from National Institute of Aging (R01AG060163, PI: Najafzadeh) and Food and Drug Administration (U01 FD007213, PI: Najafzadeh) and currently works as Senior Director, Medidata AI, at Dassault Systèmes company. Dr. Patorno was supported by a grant from National Institute of Aging (5K08AG055670) and is currently supported by a grant from the Food and Drug Administration (5U01FD007213). Dr. Schmedt and Dr. Déruaz-Luyet are employees of Boehringer Ingelheim International GmbH. Dr. Koeneman is an employee of and owns stock in Eli Lilly and Company. DJW reports serving on data monitoring committees for Novo Nordisk.

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