Comparing Out-of-Pocket Costs and Health-Related Quality of Life Between Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes

Sisi Hu,1 Preeti Pushpalata Zanwar,1– 3 Tara Jenkins,1 Rajkumar J Sevak,1 Bhaskara R Jasti1 1Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA; 2Thomas Jefferson University, Philadelphia, PA, USA; 3Texas A&M University, College Station & Kingsville, Kingsville, TX, USACorrespondence: Bhaskara R Jasti, Thomas J. Long School of Pharmacy, University of the Pacific, 3601 Pacific Ave, Stockton, CA, 95211, USA, Tel +1 209 946-3162, Email [email protected]: To compare the impact of sodium-glucose cotransporter 2 inhibitor (SGLT2 inhibitor), glucagon-like peptide-1 receptor agonist (GLP-1 RA), with or without metformin, on out of pocket and total prescription expenditure and health-related quality of life (HRQoL) for patients with type 2 diabetes mellitus (T2DM).Patients and Methods: This observational study utilized 2017– 2021 Medical Expenditure Panel Survey (MEPS) data from patients with T2DM (≥ 18 years) on SGLT2 inhibitor, GLP-1 RA, with or without metformin, from payer and self-perspective. HRQoL was assessed using physical (PCS) and mental component summary (MCS) scores based on Veterans Rand 12. This study estimated survey-weighed out-of-pocket (OOP) costs for prescription refills and total prescription expenditures. Propensity score matching was used to mitigate selection bias and health expenditures, and HRQoL were compared using the Mann–Whitney U-test. P-value thresholds were recalculated using Bonferroni adjustment (Total prescription expenditure or OOP, PCS, and MCS: p=0.017).Results: Patients on GLP-1 RA alone had significantly higher OOP costs than those on SGLT2 inhibitor alone (median: &dollar;166.50 vs &dollar;81.00, p< 0.01). No significant difference existed between the two treatments for total prescription expenditures (median: &dollar;9831.53vs. &dollar;9458.80, p=0.059), MCS (median:52.41 vs 53.48, p=0.40), or PCS (median: 45.22 vs 44.54, p=0.19). Patients on metformin with GLP-1 RA had higher OOP costs compared to those on SGLT2 inhibitor with metformin (median: &dollar;140.40 vs &dollar;107.33, p < 0.01). There is a significant difference between the combination treatments for total prescription expenditure (median: &dollar;9453.96 vs &dollar;6711.47, p< 0.01), MCS (median: 54.19 vs 54.30, p=0.70), or PCS (median: 45.69 vs 46.08, p=0.55).Conclusion: Even though patients on GLP-1 RA have higher OOP costs, the difference in PCS or MCS scores between GLP-1 RA and SGLT2 inhibitor was not significant. Further investigation is needed to study the long-term impact on HRQoL and clinical outcomes.Keywords: SGLT2 inhibitor, GLP-1 receptor agonist, medical expenditure panel survey, health care expenditure, health-related quality of life