Objective
We compared health care resource utilization (HCRU) and costs for inpatient and outpatient services and dispensed medications in older adults with type 2 diabetes initiating empagliflozin versus dipeptidyl peptidase 4 inhibitors (DPP-4is).
Research Design and Methods
The study population included U.S. Medicare fee-for-service beneficiaries with diabetes (age ≥65 years) initiating empagliflozin or DPP-4is (August 2014 to September 2018).
We estimated rate ratios (RRs) for HCRU outcomes using zero-inflated negative binomial regression and per-member per-year (PMPY) cost differences using generalized linear model with gamma distributions, overall and stratified by baseline cardiovascular disease (CVD), after adjusting for 143 baseline covariates using 1:1 propensity score matching.
Results
We identified 23,335 matched pairs (mean age 72 years, 51% with baseline CVD). HCRU rates were lower in empagliflozin versus DPP-4i initiators:
- number of inpatient days: RR 0.89 [95% CI 0.82, 0.97]
- number of emergency department (ED) visits: 0.86 [0.82, 0.91]
- number of hospitalizations: 0.86 [0.79, 0.93]
- number of office visits: 0.96 [0.95, 0.98]
Costs were lower for empagliflozin versus DPP-4is:
- inpatient cost: -$713 PMPY [95% CI -847, -579]
- outpatient cost: -$198 PMPY [-272, -124]
- total cost of care: -$1,109 PMPY [-1,478, -739]
Diabetes medication cost, however, was higher in empagliflozin initiators ($454 PMPY [95% CI 284, 567]).
In the CVD subgroup, total cost was lower for empagliflozin initiators (-$2,005 PMPY [-2,451, -1,337]), while the difference was attenuated in the non-CVD subgroup (-$296 PMPY [-740, 148]).
Conclusions
Among older adults with diabetes, empagliflozin was associated with a lower number of inpatient days, hospitalizations, ED visits, and office visits and with lower costs of care compared with DPP-4is, especially in those with history of CVD.
© 2024 by the American Diabetes Association.
