Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease
Authors' conclusion
In this cohort study of more than 80 000 older adults with T2D and established CVD covered by Medicare Advantage and commercial plans, those in the highest quartile of OOP cost were 13% and 20% less likely to initiate a GLP-1 RA or SGLT2 inhibitor, respectively, when compared with those in the lowest quartile of OOP costs.
Study context
- Population
- Adults with T2D and established cardiovascular disease (CVD) on metformin monotherapy, Optum Clinformatics Data Mart 2017–2021; mean age 72 years, 55.8% male, 88% Medicare Advantage
- Participants
- 80,807 adults
- Exposure
- Highest vs lowest quartile of out-of-pocket (OOP) costs for SGLT2i and GLP-1 RA
- Outcome
- Treatment intensification: new dispensing (initiation) of an SGLT2i or GLP-1 RA, analysed per drug class
Methodological detailsCox proportional hazards models, adjusted, Median follow-up 1080 days (IQR 528 to 1337)
- Cox proportional hazards models, adjusted
- Median follow-up 1080 days (IQR 528 to 1337)
Main finding
As reported in the abstract
Initiation of GLP-1 RA; initiation of SGLT2i
Q4 vs Q1Adjusted hazard ratio (95% CI)
GLP-1 RA initiation
0.87(0.78–0.97)
SGLT2i initiation
0.80(0.73–0.88)
Observational data: associations, not effects.
Further findings
Days to initiating GLP-1 RA
Days to initiating SGLT2i
Mean $
| Outcome | Q4 | Q1 |
|---|---|---|
| Monthly OOP cost for GLP-1 RA | 118 (SD 32) | 25 (SD 12) |
| Monthly OOP cost for SGLT2i | 91 (SD 25) | 23 (SD 9) |
Original publication
Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease. JAMA Netw Open. Published 1 June 2023. doi:10.
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