Sodium-Glucose Cotransporter 2 Inhibitors for Prevention of Heart Failure Events in Patients with Type 2 Diabetes Mellitus: A Cost Per Outcome Analysis

Clin Drug Investig. 2020 Jul;40(7):665-669. doi: 10.1007/s40261-020-00929-z.


Background and objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have significant efficacy in reducing the risk of hospitalization for heart failure (hHF) or cardiovascular (CV) mortality in patients with type 2 diabetes mellitus (T2DM). However, there are differences in HF outcomes between the SGLT2i. Therefore, we compared the cost needed to achieve these outcomes between empagliflozin, canagliflozin, and dapagliflozin.

Methods: We calculated the cost needed to treat (CNT) in order to prevent one event of hHF or CV mortality, by multiplying the annualized number needed to treat (NNT) to prevent one event, by the annual cost of each therapy. Efficacy estimates were extracted from published randomized controlled trial (RCT) data. A sensitivity analysis was performed to mitigate differences between the RCT populations. Drug costs were extracted from the 2020 US National Average Drug Acquisition Cost listing.

Results: We figured empagliflozin's CNT to be $664,464 (95% CI $499,872-$1,097,280), $1,535,387 (95% CI $886,074-$3,210,501) for canagliflozin, and $2,693,145 (95% CI $1,639,563-$11,092,206) for dapagliflozin. The sensitivity analysis confirmed the cost advantage of empagliflozin.

Conclusions: Our findings suggest that empagliflozin prescribed for preventing CV death or hHF in T2DM patients seems to be cost saving compared to treatment with canagliflozin, and dapagliflozin.

MeSH terms

  • Benzhydryl Compounds / therapeutic use
  • Canagliflozin / therapeutic use
  • Cardiovascular Diseases / mortality
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Glucosides / therapeutic use
  • Health Care Costs
  • Heart Failure / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Sodium-Glucose Transporter 2 Inhibitors / economics
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use*


  • Benzhydryl Compounds
  • Glucosides
  • Sodium-Glucose Transporter 2 Inhibitors
  • Canagliflozin
  • empagliflozin