Reifsnider OS, Pimple P, Brand S, et al. - From the United States (US) payer perspective, second-line empagliflozin (sodium-glucose co-transporter 2 inhibitor) combined with metformin for type 2 diabetes (T2D) is a dominant strategy that affords extended survival, improved quality-adjusted life-years (QALYs), and lower costs relative to second-line liraglutide (glucagon-like peptide-1 receptor agonist).

• Using an economic simulation model with a lifetime horizon, cost-effectiveness of sequential use of empagliflozin and liraglutide after metformin for T2D was estimated for US payers.

• Employing EMPA-REG OUTCOME data or United Kingdom Prospective Diabetes Study risk equations, T2D-related complications were estimated in patients with or without a history of cardiovascular disease (CVD), respectively.

• In the overall T2D population, lower total lifetime cost ($11,244/patient less) and a QALY gain (0.32/patient) were conferred by second-line empagliflozin vs second-line liraglutide.

• In patients with CVD, second-line empagliflozin, vs second-line liraglutide, led to decreases in CV death (by 5%) and lower cumulative complication rates (by 2%).

• These results were consistent in cases with comorbid CVD, with gains in incremental QALYs (0.43/patient) and lower lifetime cost (by $10,175/patient) vs second-line liraglutide.

• Dominance for second-line empagliflozin was consistently revealed in scenario analyses.