Cost-utility of empagliflozin in patients with type 2 diabetes at high cardiovascular risk

J Diabetes Complications. 2018 Feb;32(2):210-215. doi: 10.1016/j.jdiacomp.2017.10.006. Epub 2017 Oct 14.


Aims: In the Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG) trial, empagliflozin reduced cardiovascular and all-cause mortality in type 2 diabetes (T2D) patients at high cardiovascular risk. We sought to estimate the cost-effectiveness of empagliflozin versus standard treatment for the prevention of cardiovascular morbidity and mortality in patients with T2D.

Methods: A Markov model was developed to assess the cost-effectiveness of empagliflozin (versus standard treatment) for the prevention of cardiovascular morbidity and mortality in patients with T2D using a 3-month cycle length and a lifetime horizon. Data sources included the EMPA-REG randomized clinical trial and other published epidemiological studies. Outcomes included treatment costs (in 2016 US$), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Probabilistic sensitivity analysis (PSA) was performed to test the robustness of conclusions.

Results: Empagliflozin use resulted in higher total lifetime treatment costs ($371,450 versus $272,966) but yielded greater QALYs (10.712 vs. 9.419) compared to standard treatment. This corresponded to an ICER of $76,167 per QALY gained. PSA suggested empagliflozin would be cost-effective in 96% of 10,000 iterations assuming a willingness-to-pay threshold of $100,000 per QALY gained.

Conclusion: Empagliflozin may be cost-effective compared to standard treatment in T2D patients at high cardiovascular risk.

Keywords: Cost-effectiveness; Cost-utility study; Diabetes mellitus; Economic evaluation; Empagliflozin; SGLT2 inhibitor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Benzhydryl Compounds / economics*
  • Benzhydryl Compounds / therapeutic use*
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetic Angiopathies / economics
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / prevention & control*
  • Drug Costs
  • Female
  • Glucosides / economics*
  • Glucosides / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Morbidity
  • Quality-Adjusted Life Years
  • Risk Factors
  • Treatment Outcome


  • Benzhydryl Compounds
  • Glucosides
  • empagliflozin