Health economic analysis shows canagliflozin monotherapy may reduce costs of type 2 diabetes

Results from a health economic and outcomes research (HECOR) simulation analysis show that canagliflozin (Invokana, Janssen), along with lifestyle management, may reduce long-term complications and associated costs for adult patients with type 2 diabetes compared to a treatment sequence without canagliflozin.

Results from the simulation analysis found that a treatment sequence starting with canagliflozin, along with lifestyle management, may reduce long-term complications for adult patients with type 2 diabetes compared to a treatment sequence starting without canagliflozin (starting with lifestyle management alone). The analysis predicted that, compared to a treatment sequence without canagliflozin, the treatment sequence starting with canagliflozin, 100-mg and 300-mg doses, would reduce the risk of microvascular events (eg, vision problems and blindness, nerve problems, and loss of kidney function) by up to 36% over a 30-year treatment simulation.

“Canagliflozin may reduce long-term health costs associated with type 2 diabetes,” according to Silas Martin, co-author HECOR simulation analysis, and director, health economics and outcomes research, Janssen Scientific Affairs.

The improved outcomes were associated with lower healthcare costs, by approximately $5,500 and $4,000 for the 300-mg and 100-mg doses, respectively, and improved quality of life over 30 years.

Economic modeling has been widely used as a tool for generating long-term health economic data regarding future outcomes of patients with type 2 diabetes, according to Martin.

“These models use shorter-term clinical trial results and apply evidence-based mathematical equations to forecast the onset of complications, survival, and associated health-related quality of life,” Martin told Formulary. “Because type 2 diabetes is a life-long condition, it is important not only to know if a therapy improves blood glucose control and other health risk factors, but also how those improvements may affect long-term health outcomes and costs.”

The purpose of this simulation analysis was to assess the long-term outcomes and cost of complications associated with treatment regimens beginning with canagliflozin 100 mg and 300 mg plus lifestyle management versus lifestyle management alone in patients with type 2 diabetes, by extrapolating from shorter-term randomized controlled trial results using a validated economic microsimulation model.

Martin and colleagues based the model on results from a previously reported (Stenlof et al, Diab Obes Metab 2013) 26-week, randomized, double-blind, placebo-controlled phase 3 trial (DIA3005) in 584 adults with type 2 diabetes inadequately controlled with lifestyle management.

“That allowed us to specifically show, in the simulation analysis, the effect of Invokana monotherapy,” Martin said. “Because DIA3005 included patients fairly early in treatment for their disease, it enabled the analysis to simulate outcomes over a long period of time-30 years.”

The analysis also found that taking canagliflozin would postpone the need for treatment intensification. The researchers projected that, within a year, 20% and 13% of patients starting a treatment sequence with canagliflozin 100 mg and 300 mg, respectively, would require subsequent sulfonylurea therapy, compared to 43% of patients starting with lifestyle management alone. Within 10 years, insulin would be required by 27% and 19% of patients starting with canagliflozin 100 mg and 300 mg, respectively, compared to 66% starting with lifestyle management alone.

“Future HECOR analyses will look at the other settings where we studied canagliflozin, for example, in combination therapy and compared to other agents,” Martin said.

Results of the HECOR simulation analysis were presented at the American Diabetes Association 73^rd Scientific Session in June.