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

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

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Idaho State University, College of Pharmacy, Meridian, ID, USA.
University of Connecticut, Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA.
University of Connecticut, School of Business, Hartford, CT, USA.
Medical University of South Carolina, College of Pharmacy, Charleston, SC, USA. Electronic address:



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.


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.


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.


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


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

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