Health Care Utilization and Costs Associated With Empagliflozin in Older Adults With Type 2 Diabetes

• DOI: 10.2337/dc24-0270
• Publication Date: 2024-06-25T18:33:02Z
• Authors: Phyo Than Htoo; Mehdi NajafZadeh; Helen Tesfaye; Sebastian Schneew...; Deborah J. Wexler; Robert J. Glynn; Niklas Schmedt; Anouk Déruaz-Luyet; Lisette Koeneman; Julie M. Paik; Elisabetta Patorno
• Keywords: Male; Aged, 80 and over; Dipeptidyl-Peptidase IV Inhibitors; Health Care Costs; Patient Acceptance of Health Care; Medicare; United States; Hospitalization; 03 medical and health sciences; 0302 clinical medicine; Diabetes Mellitus, Type 2; Glucosides; Humans; Hypoglycemic Agents; Female; Benzhydryl Compounds; Sodium-Glucose Transporter 2 Inhibitors; Aged

OBJECTIVE We compared health care resource utilization (HCRU) and costs for inpatient and outpatient services and dispensed medications in older adults with type 2 diabetes initiating empagliflozin versus dipeptidyl peptidase 4 inhibitors (DPP-4is).

RESEARCH DESIGN AND METHODS The study population included U.S. Medicare fee-for-service beneficiaries with diabetes (age ≥65 years) initiating empagliflozin or DPP-4is (August 2014 to September 2018). We estimated rate ratios (RRs) for HCRU outcomes using zero-inflated negative binomial regression and per-member per-year (PMPY) cost differences using generalized linear model with gamma distributions, 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% with baseline CVD). HCRU rates were lower in empagliflozin versus DPP-4i initiators (number of inpatient days, RR 0.89 [95% CI 0.82, 0.97]; number of emergency department [ED] visits, 0.86 [0.82, 0.91]; number of hospitalizations, 0.86 [0.79, 0.93]; number of office visits, 0.96 [0.95, 0.98]). Inpatient cost (−$713 PMPY [95% CI −847, −579), outpatient cost (−$198 PMPY [−272, −124]), and total cost of care (−$1,109 PMPY [−1,478, −739]) were lower for empagliflozin versus DPP-4is, although diabetes medication cost was higher in empagliflozin initiators ($454 PMPY [95% CI 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 a lower number of inpatient days, hospitalizations, ED visits, and office visits and with lower costs of care compared with DPP-4is, especially in those with history of CVD.