New health economics data supports expanded PBS listing of diabetes medicines

Pharma News: A new class of diabetes medicines that have shown to reduce the incidence of cardiovascular and kidney disease are a cost-effective option to treat Australia’s entire population of people with type 2 diabetes, a new study has found.

The study analysed the cardiovascular and kidney health benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2is), taking into account the economic costs for government.

SGLT2is is a newer class of diabetes medication and includes AstraZeneca’s Forxiga (dapagliflozin), Boehringer Ingelheim’s Jardiance (empagliflozin) and MSD’s Steglatro (ertugliflozin) which are currently available in Australia. SGLT2i use leads to a 33% reduction in hospitalisation for heart failure (HF) and a 35% reduction in the incidence of end-stage kidney disease.

Lead researcher, Jedidiah Morton, from the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences, said this is the first study he is aware of that has explored whether SGLT2is are cost-effective treatments when considering only their cardiovascular and kidney benefits.

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“People living with type 2 diabetes are at high risk of heart attacks, stroke, heart failure and end-stage kidney disease, but some medicines that target these critical health conditions are not currently subsidised for everyone at risk,” Mr Morton said.

“The Pharmaceutical Benefit Scheme (PBS) criteria restricts subsidised use of SGLT2is to people who have ‘uncontrolled’ glucose, potentially limiting access to people who could benefit,” he said.

The study found that SGLT2is are a cost-effective option to treat all people living with type 2 diabetes, regardless of whether or not they have challenges managing their blood glucose levels.

“SGLT2i use met the AU$28,000 per QALY willingness-to-pay threshold in most one-way sensitivity and scenario analyses in both populations, and also did so in most probabilistic sensitivity analyses, especially in the secondary prevention population. These findings suggest that the cardiovascular and kidney benefits of treatment with SGLT2is are worth the cost for all people with type 2 diabetes, regardless of use of other medications or their HbA_1c levels.

“Our results suggest that the current reimbursement criteria that limit the use of SGLT2is among people with type 2 diabetes may need to be reconsidered,” wrote the authors.

Clinical guidelines for people with type 2 diabetes were updated in 2019 to recommend their use in people with, or at risk for, cardiovascular and kidney disease.

According to Diabetes Australia, almost 1.9 million people are currently living with diabetes including an estimated 500,000 people with silent, undiagnosed type 2 diabetes.

Diabetes Australia Group CEO Justine Cain said the findings could be good news for people living with type 2 diabetes.

“Kidney and heart disease are two of the most common diabetes-related complications with around 380,000 Australians living with kidney disease and/or cardiovascular disease as well as diabetes. So it’s important that more Australians can access medicines like these to help them live well and reduce the impact of diabetes-related complications on our health system,” Ms Cain said.

Head of Diabetes and Population Health at the Baker Institute, Professor Dianna Magliano, said “With the increase in the number of people with diabetes and/or with a longer duration of diabetes we may see a higher incidence of diabetes-specific complications such as kidney failure and cardiovascular disease.

“We therefore need to look at ways to address rising healthcare costs and to improve quality of life for people with type 2 diabetes.”

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