Clinical Utility and Cost-Effectiveness of SGLT2 Inhibitors in a Full Risk Value-Based Care Model

Background: SGLT2i have significant clinical benefits for patients with chronic kidney disease (CKD) with type 2 diabetes mellitus (DM). However, adoption rates have been lower than expected. These medications are expensive, and payers typically require prior authorization. We evaluated the clinical utility and cost effectiveness of SGLT2i in a cohort of patients with DM in a full risk model of care. Methods: We evaluated the impact of SGLT2i prescription in 10,365 Medicare beneficiaries with stage 4 CKD and DM being cared for by nephrologists in partnership with Evergreen Nephrology. Utilizing claims data from 1/1/2023 to 6/30/2023, we compared the costs of patients who had not filled a prescription for an SGLT2i (Cohort 1 n= 8733) with patients who had filled a prescription for an SGLT2i (Cohort 2 n=1632). Results: Total medical expenses not including Part D drug cost in Cohort 1 were $3,007 per member per month (PMPM) and in Cohort 2 were $2,457 PMPM. This is an 18.3% reduction. Costs were lower in most settings but were driven significantly by reduction in hospitalization (-25.7%) and skilled nursing facility utilization (-36.6%) consistent with known clinical benefits of SGLT2i (Table 1). When Part D costs are included, the savings are maintained albeit at lower level (Figure 1). Conclusion: SGLT2i reduce inpatient and other drivers of the high cost of care for patients with stage 4 CKD and DM. This reduction is preserved even when including the cost of these expensive medications. These savings should motivate payers and providers in value-based care to remove barriers to patient access to these important medications.Table 1Figure 1