Table 4.
Cost-effectiveness results: scenarios with and without treatment effect on hHF
| Analysis | Including treatment effect on hHF | ||||||
|---|---|---|---|---|---|---|---|
| Life-years (years) | QALY (years) | Total cost (£) | ICUR | ||||
| Empagliflozin | Oral semaglutide | Empagliflozin | Oral semaglutide | Empagliflozin | Oral semaglutide | ||
| Base case scenario analyses | |||||||
| Treatment intensification at HbA1c threshold of 7.5%a | 14.01 | 13.93 | 9.27 | 9.25 | 28, 193 | 34, 441 | Dominant |
| Exploratory analyses | |||||||
| Further intensificationb | 13.95 | 13.94 | 9.17 | 9.19 | 24,302 | 26,396 | 83,748* |
| Treatment intensification at HbA1c threshold of 8%a | 14.01 | 13.92 | 9.30 | 9.28 | 27,021 | 33,300 | Dominant |
| BMI polynomial utility approachb | 13.95 | 13.94 | 9.51 | 9.53 | 24,302 | 26,396 | 91030* |
| Time horizon of 5 years | 4.37 | 4.37 | 3.02 | 3.04 | 6,202 | 7738 | 73152* |
| Analysis | Excluding treatment effect on hHF | ||||||
|---|---|---|---|---|---|---|---|
| Life-years (years) | QALY (years) | Total cost (£) | ICUR | ||||
| Empagliflozin | Oral semaglutide | Empagliflozin | Oral semaglutide | Empagliflozin | Oral semaglutide | ||
| Base case scenario analyses | |||||||
| Treatment intensification at HbA1c threshold of 7.5%a | 13.93 | 13.93 | 9.22 | 9.25 | 28, 280 | 34, 441 | 186, 690 |
| Exploratory analyses | |||||||
| Further intensificationb | 13.94 | 13.94 | 9.16 | 9.19 | 24, 348 | 26, 396 | 53, 874* |
| Treatment intensification at HbA1c threshold of 8%a | 13.90 | 13.92 | 9.23 | 9.28 | 27,032 | 33,300 | 394,892* |
| BMI polynomial utility approachb | NA | NA | NA | NA | NA | NA | NA |
| Time horizon of 5 years | 4.37 | 4.37 | 3.02 | 3.04 | 6238 | 7738 | 65,233* |
The ICUR refers to the cost (GBP) per QALY for empagliflozin plus metformin versus oral semaglutide plus metformin
GBP Pound sterling, HbA1c glycated haemoglobin, hHF hospitalisation for heart failure, ICUR incremental cost-utility ratio, NA not applicable, QALY quality-adjusted life year
aTwo lines of treatment: empagliflozin or oral semaglutide in addition to metformin; treatment intensification—empagliflozin or oral semaglutide in addition to insulin glargine
bThree lines of treatment: empagliflozin or oral semaglutide in addition to metformin; initial intensification—empagliflozin or oral semaglutide in addition to insulin glargine; further intensification—high-dose insulin glargine alone
*With positive net monetary benefit