Author: Eleanor McDermid
medwireNews: The authors of a modeling study say that the price of sodium-glucose cotransporter (SGLT)2 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists would need to fall “by at least 70%” for them to be cost effective as first-line treatments in the USA.
The “major driving factors” underlying the poor cost effectiveness of these medications in the first line relative to metformin were “their high costs and a decrease in quality of life associated with injections,” say Neda Laiteerapong (University of Chicago, Illinois, USA) and co-researchers.
As reported in the Annals of Internal Medicine, the investigators based their model on the UKPDS Outcomes Model version 2, modified to incorporate the effects of SGLT2 inhibitors and GLP-1 receptor agonists on glucose control as well as factors such as blood pressure, weight, and cardiovascular risk.
They applied the model to 493 people with type 2 diabetes who were eligible for first-line glucose-lowering medication, identified in NHANES 2013–2016. These people were an average age of 55 years, with diabetes diagnosed an average of 4.2 years previously. Fifty percent were women and 36% had diabetic complications.
The model revealed an absolute reduction in the lifetime rate of macrovascular complications of 4.4% with SGLT2 inhibitors and 5.2% with GLP-1 receptor agonists used first-line, compared with metformin, but only a marginal (0.1%) reduction in the incidence of microvascular outcomes.
Moreover, first-line use of these medications resulted in increased undiscounted life expectancy, by 3.0 and 3.4 months for SGLT2 inhibitors and GLP-1 receptor agonists, respectively, versus metformin.
However, while first-line SGLT2 inhibitor use increased discounted quality-adjusted life expectancy by 33 days, GLP-1 receptor agonist use reduced it by 22 days, because of the need to inject these medications.
The researchers calculated that first-line SGLT2 inhibitors would be cost effective at a price of US$ 1800 (€ 1834) per year ($ 5/€ 5.1 per day), based on a willingness-to-pay threshold of less than $ 150,000 (€ 152,831) per quality-adjusted life–year. And oral GLP-1 receptor agonists would become cost effective at a price of $ 2100 (€ 2140) per year ($ 6/€ 6.1 per day).
This would require price reductions of at least 70% for SGLT2 inhibitors and 90% for oral GLP-1 receptor agonists, say Laiteerapong and team.
They note that even an already available generic version of an older GLP-1 receptor agonist is relatively expensive, and that “it may take decades for medication prices to drop low enough to become affordable.”
They conclude: “Without external incentives, limited access to these drug classes will likely persist […] as will further diabetes disparities—for decades into the future—because of differential access to care due to insurance (for example, private vs. public), which often tracks race and ethnicity.”
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