FTI Center for Healthcare Economics and Policy’s Jason Shafrin, PhD, Jaehong Kim, PhD, Shanshan Wang, MS, and Moises Marin, MA, recently published an article assessing the cost-effectiveness of sotagliflozin, as adjunctive therapy to insulin, for patients with type 1 diabetes and chronic kidney disease. Sotagliflozin slowed rates of dialysis and transplant over a 10-year time frame, decreased mortality, and was found to provide good value for money. The article was published in Journal of Managed Care & Specialty Pharmacy and is titled “Cost-Effectiveness Analysis Model for Sotagliflozin Compared with Insulin Monotherapy for Patients with Type 1 Diabetes and Chronic Kidney Disease.” The study abstract is below.
ABSTRACT
Objective
To evaluate the cost-effectiveness of sotagliflozin as an add-on to insulin in patients with T1D and CKD from a US payer perspective.
Methodology
A Markov model was generated for individuals diagnosed with both T1D and comorbid CKD stage 3 from a US payer’s perspective. Clinical and economic outcomes were assessed over 30 years and included number of patients prevented from dialysis and transplantation, life-years, quality-adjusted life-year (QALY) gains, incremental costs, incremental cost-effectiveness ratio (ICER), and net monetary benefit. Dynamic pricing, through genericization, was incorporated to account for the economic impacts of market entry by generics.
Results
Sotagliflozin add-on therapy improved survival, extending life expectancy by 1.27 years (13.08 with sotagliflozin vs 11.81 with insulin monotherapy). During the first 10 years after treatment initiation, dialysis and transplant utilization decreased by 3.06 (99.35 vs 102.41) and1.73 (30.59 vs 32.32) per 1,000 patients, respectively. QALYs per patient increased by 0.63 (7.70 vs 7.07), largely driven by prolonged time in pre–end-stage renal disease health states (0.59; 6.75 vs 6.16). Total costs rose by 484,674 vs $411,760), primarily because of pharmacy costs increasing by 96,242 vs 115,677 per QALY and the model was most sensitive to pharmacy costs.
Conclusion
Sotagliflozin is a cost-effective adjunct to insulin therapy for T1D and CKD patients, providing clinical benefits and falling below the $150,000/QALY willingness-to-pay threshold in 59% of probabilistic sensitivity analysis simulations.
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