Comparing Out-of-Pocket Costs and Health-Related Quality of Life Between Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes.

Abstract

Purpose: To compare the impact of sodium-glucose cotransporter 2 inhibitor (SGLT2 inhibitor), glucagon-like peptide-1 receptor agonist (GLP-1 RA), with or without metformin, on out of pocket and total prescription expenditure and health-related quality of life (HRQoL) for patients with type 2 diabetes mellitus (T2DM).

Patients and methods: This observational study utilized 2017-2021 Medical Expenditure Panel Survey (MEPS) data from patients with T2DM (≥18 years) on SGLT2 inhibitor, GLP-1 RA, with or without metformin, from payer and self-perspective. HRQoL was assessed using physical (PCS) and mental component summary (MCS) scores based on Veterans Rand 12. This study estimated survey-weighed out-of-pocket (OOP) costs for prescription refills and total prescription expenditures. Propensity score matching was used to mitigate selection bias and health expenditures, and HRQoL were compared using the Mann-Whitney U-test. P-value thresholds were recalculated using Bonferroni adjustment (Total prescription expenditure or OOP, PCS, and MCS: p=0.017).

Results: Patients on GLP-1 RA alone had significantly higher OOP costs than those on SGLT2 inhibitor alone (median: $166.50 vs $81.00, p<0.01). No significant difference existed between the two treatments for total prescription expenditures (median: $9831.53vs. $9458.80, p=0.059), MCS (median:52.41 vs 53.48, p=0.40), or PCS (median: 45.22 vs 44.54, p=0.19). Patients on metformin with GLP-1 RA had higher OOP costs compared to those on SGLT2 inhibitor with metformin (median: $140.40 vs $107.33, p <0.01). There is a significant difference between the combination treatments for total prescription expenditure (median: $9453.96 vs $6711.47, p<0.01), MCS (median: 54.19 vs 54.30, p=0.70), or PCS (median: 45.69 vs 46.08, p=0.55).

Conclusion: Even though patients on GLP-1 RA have higher OOP costs, the difference in PCS or MCS scores between GLP-1 RA and SGLT2 inhibitor was not significant. Further investigation is needed to study the long-term impact on HRQoL and clinical outcomes.