Assessing the Value of Canagliflozin (CANA) vs. Sitagliptin (SITA) as Second-Line Therapy in the U.S.—The Importance of Considering Evidence from the CANVAS Program

Efficient allocation of health care resources requires choosing treatments that provide good “value for money”, which for chronic and progressive diseases like diabetes requires long-term modeling. For patients not controlled on metformin (MET), the ADA’s Standards of Medical Care recommend that “drug-specific effects and patient factors” guide the choice of next agent and that those with atherosclerotic CVD receive treatment with agents with evidence of CV risk reduction. The SGLT2 inhibitors CANA and empagliflozin have shown such a benefit, unlike the DPP-4s. The objective of this analysis was to estimate the cost-effectiveness of CANA vs. SITA as add-on to MET from the U.S. 3 rd party payer perspective. A comprehensive health economics model (ECHO-T2DM) was used to estimate health and cost consequences over 30 years. Baseline patient characteristics and biomarker changes were sourced from a previously reported head-to-head study of CANA vs. SITA as add-on to MET. Hazard ratios from the CANVAS Program for myocardial infarction (MI), stroke, heart failure hospitalization, and CV mortality were used to capture effects not mediated by changes in biomarkers (i.e., HbA1c, SBP, weight). Progression of DKD incorporated eGFR findings from the CANVAS program. In addition, adverse events associated with CANA were included in the simulations. Costs of health events and associated impacts on Quality-Adjusted Life Years (QALYs) were sourced from the literature. In the base case, use of CANA vs. SITA resulted in cost savings ($7,401), as well as increased longevity (0.48 years) and QALYs (0.46). The largest contributors to savings were antihyperglycemic drug costs (given less therapy intensification to maintain glucose control) and treatment costs associated with delayed DKD progression and MIs. These results suggest that the use of CANA vs. SITA as 2 nd line therapy will improve health outcomes at a reduced cost. Disclosure M. Willis: Other Relationship; Self; Janssen Global Services, LLC. C. Neslusan: Employee; Self; Janssen Global Services, LLC. A. Nilsson: Other Relationship; Self; Janssen Global Services, LLC. C. Asseburg: Other Relationship; Self; Janssen Global Services, LLC..