Usefulness of Empagliflozin Versus Liraglutide for Prevention of Cardiovascular Mortality

Empagliflozin, an inhibitor of sodium-glucose cotransporter 2 and Liraglutide, a glucagon-like peptide 1 analogue, were both proved to significantly reduce the incidence of cardiovascular (CV) death in patients with type 2 diabetes and established CV disease. However, addition of either drug to current diabetes treatment regimens may impose a significant burden on healthcare systems. We performed a cost-minimization analysis of Empagliflozin versus Liraglutide for preventing CV death. Rates of prevention of CV death were extracted from the published data of the EMPA-REG OUTCOME and LEADER trials. Drug costs were extracted from the US National Average Drug Acquisition Costs of 2017. In the EMPA-REG OUTCOME trial 5,833 patient-years of treatment with Empagliflozin resulted in the prevention of 51 CV deaths. In LEADER, 16,338 patient-years of Liraglutide resulted in the prevention of 59 CV deaths. The price in 2017 of annual Empagliflozin and Liraglutide therapy was $4,980 and $9,300, respectively. Therefore, the cost of Empagliflozin or Liraglutide needed to prevent 1 CV death would be $569,526 (95% confidence interval $415,713 to $921,798) and $2,575,312 (95% confidence interval $1,607,526 to $7,807,986), respectively. In conclusion, use of Empagliflozin for preventing CV death in type 2 diabetes patients with an established CV disease seems to be a major cost-saving strategy compared with Liraglutide. These results should be considered in the context of other individual drug and patient factors.