Health care resource utilization and costs in Medicare Advantage beneficiaries using glucagon-like peptide-1 receptor agonists vs sodium-glucose cotransporter-2 inhibitors.

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as first-line therapy for glycemic management for adults with type 2 diabetes and specific comorbidities. It is unknown whether there are meaningful differences in how GLP-1 RA vs SGLT2i therapy may affect health care resource utilization and medical costs.

Objective: To compare health care resource utilization and costs in adults with type 2 diabetes newly initiating GLP-1 RA vs SGLT2i therapy.

Methods: We used the Humana Healthcare Research database and a retrospective cohort study design to identify patients with type 2 diabetes, enrolled in a Medicare Advantage Prescription Drug plan from January 1, 2018, to June 30, 2022. Eligible patients had at least 2 pharmacy claims for a GLP-1 RA or SGLT2i drug and had at least 12 months of continuous enrollment prior to and after the first prescription claim. Propensity score matching adjusted for population differences between GLP-1 RA and SGLT2i groups. Subgroup analyses included patients with baseline atherosclerotic cardiovascular disease and obesity. Main outcomes included inpatient stays, emergency department visits, and all-cause health care costs in the 12-month follow-up period.

Results: The 1:1 matched cohort consisted of 22,167 individuals each treated with SGLT2i or GLP-1 RA, had a mean age of 68.2 years, and was 52.2% female, 73.4% White, and 18.6% Black. There were no significant differences in all-cause or diabetes-related inpatient stays or emergency department visits between GLP-1 RA and SGLT2i users for overall and subgroup analyses. Compared with SGLT2i patients, those on GLP-1 RA had 3.1% (95% CI = 0.9%-5.3%) higher medical costs in the overall cohort but 2.9% (95% CI = -5.5% to -0.2%) lower medical costs in the obesity subgroup. Pharmacy costs for patients on GLP-1 RA were 6% to 9% higher for overall and subgroup analyses, resulting in 4% to 6% higher total health care costs for GLP-1 RA users relative to SGLT2i users.

Conclusions: There were no significant differences in health care resource utilization in the overall cohort between patients taking GLP-1 RA vs those taking SGLT2i, and pharmacy and total health care costs were higher in the GLP-1 RA group. In the obesity subgroup, GLP-1 RA initiators had lower medical costs.