(092) Comparing Healthcare Utilization and Cost in Empagliflozin vs GLP-1RA Initiators with Type 2 Diabetes without Established Cardiovascular Disease

Background: Despite the established cardiovascular benefits of empagliflozin (EMPA) and glucagon-like peptide-1 receptor agonists (GLP-1RA), questions remain on their impact on healthcare resource utilization (HCRU) and costs, especially in patients with lower risk of cardiovascular disease (CVD) than patients enrolled in the cardiovascular outcome trials.

Objectives: To compare rates of HCRU and costs of care in patients in US routine care initiating EMPA vs GLP-1RA.

Methods: Using Medicare fee-for-service (FFS) and Optum commercial plan data (2014-19), we identified patients with T2D aged ≥18 years without history of CVD, who initiated EMPA or GLP-1RA. Follow-up started from drug initiation until a gap in enrollment, end of the study, death, or drug discontinuation/switching. After 1:1 propensity score (PS) matching using 143 baseline covariates, we estimated rate ratios (RR) for HCRU per 1,000 person-years and differences in reimbursed costs per member per year (PMPY) for inpatient and outpatient services and outpatient medication dispensing. We used zero-inflated negative binomial models for HCRU outcomes and gamma models for cost outcomes.

Results: We identified 28,025 matched pairs with FFS and 18,007 matched pairs with Optum commercial plans. Overall, HCRU rates in patients with FFS plans were similar between EMPA and GLP-1RA initiators: number of hospitalizations [RR: 0.99 (0.90, 1.10)], number of ED visits [RR: 0.97 (0.92, 1.03)], with slightly lower number of distinct medication classes [RR: 0.96 (0.95, 0.97)]. Corresponding costs of care were also similar: inpatient cost [PMPY: $47 (-109, 212)], outpatient cost [PMPY: -$121 (-171, -70)], and non-T2D pharmacy cost [PMPY: -$44 (-98, 11)] while T2D-related pharmacy cost was lower in EMPA [PMPY: -$710 (-856,-561)], resulting in lower total cost [RR: -$1,098 (-1,370, -821)]. In Optum, HCRU rates were also similar between treatments: number of hospitalizations: [RR: 1.03 (0.82, 1.29)] and number of ED visits [RR: 0.94 (0.83, 1.08)], while the number of distinct medication classes was lower in EMPA [RR: 0.90 (0.89, 0.92)]. Costs of care showed similar patterns: inpatient cost [PMPY: -$191 (-376, 17]], outpatient cost [PMPY: -$200 (-334, -62)], and non-T2D pharmacy cost [PMPY: -$58 (-123, 9)] while T2D-related pharmacy cost was lower in EMPA [PMPY: -$1,003 (-1191, -809)]. Total cost was lower in EMPA [PMPY: -1,294 (-1,668, -912)].

Conclusions: Among patients with T2D in US routine care settings, relative to GLP-1RA, EMPA was associated with similar hospitalization and ED visits but lower total costs of care, mainly driven by T2D-related pharmacy cost.