Cost-effectiveness of Empagliflozin Compared to Liraglutide in Iran Based on Cardiovascular Outcome Trials in Type 2 Diabetes Mellitus

Empagliflozin and liraglutide are anti-hyperglycemic agents with proven cardiovascular benefits in Type 2 Diabetes Mellitus (T2DM) patients with established Cardiovascular (CV) disease. Although both drugs are available in Iran’s pharmaceutical market, no local or regional study has analyzed the cost-effectiveness of these drugs in terms of reduction in the rate of CV-related mortality in T2DM patients in this country. In the present study, a one-year Cost-Effectiveness Analysis (CEA) was conducted based on decision-analytic modeling to compare the effectiveness of empagliflozin versus liraglutide in the prevention of CV-related death in T2DM patients in Iran.

A one-year CEA was performed to compare the effects of empagliflozin in contrast to liraglutide on the prevention of CV-related mortality from the Iranian T2DM payers’ perspective. Clinical data were extracted from the results of LEADER and EMPA-REG OUTCOME studies. Economical and cost data were taken from the FDA official website of Iran (http://irc.fda.gov.ir/nfi) and the national book of tariffs. The data then were converted to the 2021-USD using governmental conversion rates and presented in terms of Incremental Cost-Effectiveness Ratio (ICER). In order to assess the robustness of the results, scenario analysis and multiple Deterministic Sensitivity Analysis (DSA) were also performed.

Empagliflozin dominated original brand liraglutide and biosimilar liraglutide with reduced costs in preventing one extra CV-related death in T2DM patients. The annual cost was $30,585 (95%CI: $22,283- $48,745), $736,179 (95%CI: $457,206- $2,286,029), and $445,512 (95%CI: 276,686- 1,383,432) for empagliflozin, original brand liraglutide, and biosimilar liraglutide, respectively. These results were in line with the findings from scenario, base-case and deterministic sensitivity analyses.

Empagliflozin is projected to be highly cost-effective in terms of the prevention of CV-related death compared to liraglutide in Iran.