Dapagliflozin 5mg / Metformin 1g tablets

BackgroundEmpagliflozin, a sodium-glucose cotransporter 2 inhibitor, performs a reduction in the all-cause mortality and cardiovascular mortality in type 2 diabetes mellitus (T2DM) patients compared to dapagliflozin, which has been included in the national volume-based procurement in China. The objective of this study is to evaluate the long-term cost-utility of the addition of empagliflozin (10 mg or 25 mg) versus dapagliflozin (10 mg) in T2DM patients with insufficient control by metformin monotherapy from the perspective of Chinese health care payers.MethodsThe IQVIA CORE diabetes model was used for cost-utility analysis to compare the long-term economics of empagliflozin (10 or 25 mg) versus dapagliflozin (10 mg) respectively. In the two independent analyses, the discount rate was 5% per year, and the utility value was derived from the published literatures. The baseline demographic and biochemical data, as well as treatment efficacy data were obtained from the EMPA-REG MET clinical trial and network meta-analysis, respectively.ResultsCompared with dapagliflozin 10 mg, empagliflozin 10 mg and empagliflozin 25 mg improved the life expectancy by 0.011 and 0.02 years, and improved the quality adjusted life years (QALYs) by 0.011 and 0.02 years, respectively. The total cost of empagliflozin group (10 mg) was 279 Chinese Yuan lower than that of the dapagliflozin group (10 mg), making it an absolutely economical choice. The total cost of empagliflozin (25 mg) was expected to be 1,601 Chinese Yuan higher than dapagliflozin, with an incremental cost-utility ratio (ICUR) of 80,052 Chinese Yuan per QALY, below the set ‌willingness to pay (WTP) threshold of 85,698 Chinese Yuan per QALY.ConclusionFor T2DM patients with insufficient control by metformin monotherapy, the addition of empagliflozin 10 mg showed better efficacy and lower cost compared to dapagliflozin 10 mg, making it an absolutely economical choice. Based on the set WTP threshold, empagliflozin 25 mg was also a more cost-effective treatment option than dapagliflozin from the perspective of Chinese healthcare payers.

Abstract licence: CC BY

BackgroundCardiovascular disease remains the leading cause of global mortality (19.8 million deaths in 2022; 32% of all deaths worldwide). Drug repurposing-extending approved agents beyond their original indications-has emerged as a high-impact strategy in cardiovascular prevention, offering reduced development timelines, established safety profiles, and faster implementation than de novo molecular development.Study questionWhich repurposed cardiovascular agents demonstrate the most favorable pharmacoeconomic profiles, and how does the convergence of clinical benefit, patient risk stratification, and economic sustainability define the optimal hierarchy for cardiovascular prevention?Study designNarrative review synthesizing evidence from 19 pivotal cardiovascular outcomes trials and European and American guidelines. No formal meta-analysis was applied.Measures and outcomesFor 13 agents across 8 therapeutic classes, efficacy was quantified as relative and absolute risk reductions, and as the number needed to treat or to harm. Pharmacoeconomic value was assessed via incremental cost-effectiveness ratio in US dollars per quality-adjusted life year, integrating mortality in years of life lost and morbidity in years lived with disability. Primary outcomes included all-cause mortality, cardiovascular mortality, major adverse cardiovascular events, and heart failure hospitalizations.ResultsThree Incremental Cost-Effectiveness Ratio (ICER) tiers were identified: Low-cost (ConclusionsPharmacoeconomic stratification of repurposed cardiovascular agents identifies 3 distinct tiers. Generic agents-ramipril, carvedilol, metformin, and statins-demonstrate the most favorable cost-effectiveness profiles and should form the basis of any prevention protocol. SGLT2 inhibitors and GLP-1 receptor agonists offer clinically meaningful benefits in secondary prevention when applied to populations meeting pivotal trial eligibility criteria. PCSK9 inhibitors remain cost-effective only in patients with very high cardiovascular risk and inadequate LDL control on maximally tolerated statin therapy.

Abstract licence: CC BY