Economic evaluation of SGLT2 inhibitors and GLP-1 receptor agonists in Thai patients with type 2 diabetes and established atherosclerotic cardiovascular disease

Type 2 diabetes (T2D) with established atherosclerotic cardiovascular disease (ASCVD) imposes a substantial clinical and economic burden in Thailand. Although sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits, they are not currently included in Thailand’s National List of Essential Medicines (NLEM). This study assessed the cost-effectiveness of adding SGLT2i or GLP-1 RAs to standard of care (SoC) for Thai patients with T2D and established ASCVD to inform reimbursement and pricing policy. A hybrid decision tree-Markov model with a 1-year cycle length was developed from a societal perspective to estimate lifetime costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for add-on therapy versus SoC alone. Model inputs were derived from subgroup analyses of randomized controlled trials, national administrative databases, hospital records, and patient-reported data. Costs and outcomes were discounted at 3% annually, and uncertainty was explored through sensitivity analyses. All add-on therapies increased QALYs relative to SoC alone, with canagliflozin providing the greatest gain. However, all ICERs exceeded Thailand’s willingness-to-pay threshold, indicating that these therapies are unlikely to be cost-effective at current prices and supporting the need for price negotiation and targeted reimbursement strategies.