Abstract
Background: Type 2 diabetes metallis (T2DM) is one of the public health problem that burden worldwide including Thailand. Presently, T2DM patients were 4.6 million and health expenditures for T2DM treatment were 35 – 84 billion Baht. SGLT-2 inhibitor was new hypoglycemic drug and clinical studies reported that SGLT-2 inhibitors reduce cardiovascular mortality and cardiovascular events. SGLT-2 inhibitor has not been included in National List of Essential Medicine (NLEM) in Thailand. Economic evaluation studies of SGLT-2 inhibitors showed cost effective of SGLT-2 inhibitor in other countries but there was no study in Thailand. Method: The objectives of this study were to evaluate cost-utility and budget impact analysis of SGLT-2 inhibitors for T2DM treatment in high risk cardiovascular disease patients. Markov model was conducted to estimate costs and health outcomes for life time horizon with 1 year cycle. Parameters were derived from literature reviews, meta-analysis, standard costing guideline and data collections. The results were presented as incremental cost effectiveness ratio (ICER) in Thai Baht per LY or QALY gained as societal perspective. One-way sensitivity and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. Result: The results showed that life year (14.32) and QALYs (11.88) of patients who received SGLT-2 inhibitors were longer than patients who received placebo (life year 13.83 and QALYs 11.46). The ICERs showed that SGLT-2 inhibitors were not cost effective in Thailand at willingness to pay 160,000 Baht per QALY gained. Empagliflozin was most cost-effective compare to Cangliflozin and Dapagliflozin which the ICERs were 259,000, 485,000, 921,000 Baht per QALY respectively. Moreover, SGLT-2 inhibitors group compared to placebo, the ICERs was 475,000 Baht per QALY. Policy recommendation: 1. The price of SGLT-2 inhibitors should reduce to be cost-effective at willingness to pay at 160,000 Baht per QALY gained for 63% reduction. 2. Empagliflozin Cangliflozin and Dapagliflozin were not cost-effective at willingness to pay for 160,000 Baht per QALY gained) but should be negotiated to be costeffective by 38%, 64% and 79% reduction, respectively.
