Health Economic and Outcomes Research: Canagliflozin for Type 2 Diabetes

Diabetes is an ongoing medical problem that clinicians treat daily. The incidence of diabetes in the United States is increasing at an alarming rate. More than 29 million Americans have diabetes, up from the previous estimate of 26 million in 2010, according to data from the Centers for Disease Control and Prevention. Properly treating diabetes is essential because of the many comorbidities (eg, kidney failure, obesity, coronary artery disease, hypertension, and stroke) and complications associated with uncontrolled diabetes. The disease is also costly in economic terms. An American Diabetes Association study found that the economic burden of diabetes, including diagnosed diabetes and undiagnosed diabetes, gestational diabetes, and prediabetes, exceeded more than $322 billion in excess medical costs and lost productivity in 2012 [Diabetes Care. 2014;37(12):3172-3179].

Type 2 diabetes continues to be a challenging disease to manage. While treatment of type 2 diabetes is targeted at lowering glycated hemoglobin (HbA1c), clinicians also need to factor in the efficacy and tolerability of antidiabetes agents, patient preference (eg, ease of administration, dosing frequency, and hypoglycemic risk), and cost. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors is one of the newer classes of oral diabetes medications for glucose control. SGLT-2 is responsible for the majority of glucose reabsorption in the renal proximal tubule. By reducing the renal capacity to reabsorb filtered glucose, SGLT-2 inhibitors increase excretion of excess glucose in urine, thereby decreasing plasma glucose concentration [Postgrad Med. 2014;126(6):33-48].

Canagliflozin, a once-daily SGLT-2 inhibitor FDA-approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes, has been shown effective in a phase 3 clinical trial program of 10,282 patients. Because efficacy, patient adherence and preference, and cost implications are important when selecting treatment, First Report Managed Care conducted a review of health economic and outcomes research data and identified 3 studies that examined these criteria. One study focused on the pharmacology and pharmacokinetics, efficacy, safety, and cost of canagliflozin. A second study reviewed the evidence for SGLT-2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, including a cost comparison. The final study compared clinical outcomes and cost efficiency of canagliflozin versus the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin. This article provides an overview of these studies.