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