Comparative healthcare resource utilization and costs of empagliflozin and GLP-1 receptor agonists in type 2 diabetes.

Aims: Understanding the real-world impact of treatment with empagliflozin and glucagon-like peptide-1 receptor agonists (GLP-1RA) on healthcare resource utilization (HCRU) and costs could help inform clinical decision-making and healthcare policy.

Materials and methods: We conducted a comparative-effectiveness cohort study comparing HCRU and costs following empagliflozin versus GLP-1RA treatment in adults with type 2 diabetes (≥18 years) using US Medicare and commercial claims (08/2014-09/2019). We estimated rate ratios (RR) for HCRU outcomes using zero-inflated negative binomial regression and cost differences per member per year (PMPY) using gamma regression after adjusting for 143 baseline covariates via propensity score matching.

Results: We identified 146,341 matched pairs across all databases. After matching, the rates of hospital days, hospitalizations, emergency department (ED) visits, and physician office visits were similar between treatments. Empagliflozin had lower rates of dispensed medication classes versus GLP-1RA across most databases (RRs ranged from 0.91 to 0.95, RDs from -1246 to -709 per 1000 PY, reflecting varying degrees of precision). Total costs of care were lower with empagliflozin versus GLP-1RA. PMPY ratios ranged from 0.93 to 0.97 and differences from -$1425 to -$847. Inpatient and outpatient costs were comparable between treatments. Empagliflozin had lower pharmacy costs than GLP-1RA, mainly driven by glucose-lowering medications (PMPY ratios ranging from 0.91 to 0.95; PMPY differences from -$799 to -$441).

Conclusions: Among adults with diabetes, empagliflozin was associated with similar rates of inpatient days, hospitalizations, ED, and office visits, with lower dispensed medication rates compared with GLP-1RA. Empagliflozin initiators incurred lower total costs, driven by lower glucose-lowering medication costs.