Introduction:

The healthcare industry is continually evolving, with medical advancements reshaping the way we approach disease management. One area of significant progress is in the treatment of Type 2 Diabetes (T2D), where Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors are emerging as a potent weapon, particularly to manage other comorbidities such as cardiac failure, kidney function and anaemia. Besides their glucose-lowering and kidney-protective effects, SGLT2s have the potential to increase haemoglobin levels in T2D patients. This article we have a closer look at the efficacy and cost-effectiveness of SGLT2 inhibitors, providing insight into their potential role in the future for various conditions.

SGLT2 Inhibitors and Anaemia Prevention:

SGLT2 inhibitors have demonstrated effectiveness in the management of T2D, congestive heart failure (CCF), and chronic kidney disease (CKD). These inhibitors work by reducing the reabsorption of glucose in the kidneys, thereby lowering blood glucose levels. Anaemia commonly affects patients with T2D and it is associated with higher mortality rates. This condition also lowers the quality of life. Currently, healthcare guidelines do not include precise recommendations for adjuvant therapy aimed at preventing the onset of anaemia.

Recent studies suggest a significant role for SGLT2 inhibitors in mitigating risks of CKD and anaemia in patients with T2D. These inhibitors are linked to a 38% risk reduction in kidney outcomes. They also correlate with increased haemoglobin levels in these patients. 

The Cost-Effectiveness of SGLT2 Inhibitors in Heart Failure

SGLT2 inhibitors have shown promising results in the management of heart failure with preserved ejection fraction (HFpEF), a condition affecting approximately 3 million US adults. Recent clinical trials have demonstrated that SGLT2 inhibitors significantly reduced the risk of heart failure hospitalisation or cardiovascular death compared to a placebo.

However, the cost-effectiveness of these drugs is a crucial consideration. Currently, the average wholesale price for a one-year supply of SGLT2 inhibitors is approximately $8000, while the Federal Supply Schedule cost is about $4500. This high cost could significantly increase pharmaceutical spending, potentially hindering the widespread uptake of these effective cardiovascular therapies.

The Economic Value of SGLT2 Inhibitors

An economic evaluation using a simulation model of US adults with HFpEF projected that adding an SGLT2 inhibitor to standard care would increase quality-adjusted survival by 0.19 years (equivalent to approximately 69 additional days of perfect health). However, it would also increase lifetime costs by $26,300. This results in an incremental cost-effectiveness ratio (ICER) of $141,200 per quality-adjusted life year (QALY) gained, which is considered an intermediate-value strategy.

However, the economic value is sensitive to the association with cardiovascular mortality. A small increase in cardiovascular mortality could make SGLT2 inhibitors a low-value strategy. If the annual cost of SGLT2 inhibitors is lowered to $1431, a 68% reduction from the current Veterans Affairs price and a 78% reduction in wholesale acquisition cost, SGLT2 inhibitors could be considered high to intermediate value.

Conclusion

While SGLT2 inhibitors offer significant benefits in managing T2D, CKD, anaemia, and CCF, their high cost can be a barrier to their widespread use. However, the potential availability of generic versions of these drugs could significantly improve their cost-effectiveness. The healthcare industry constantly aims to offer superior, more cost-efficient solutions for patients. Consequently, we anticipate an increased role for SGLT2 inhibitors in managing these conditions.