Impact of Switching from Sulfonylureas to Dipeptidyl Peptidase-4 Inhibitors on Hypoglycemia Burden in the United States—A Predictive Modeling Approach

Hypoglycemia requiring medical care represents significant burden for patients with T2DM and health systems. Therefore, minimizing risk of hypoglycemia needs to be considered in treatment decision making, in addition to attaining glycemic goal. Using a predictive modeling approach, we conducted a study to estimate reduction in hypoglycemia event rates and costs that may result from switching from sulfonylureas (SU) to dipeptidyl peptidase-4 inhibitors (DPP-4i) in the United States. A large commercial claims database was used to identify adult T2DM patients newly treated with SU or DPP-4i in 2014. Rates and costs of hypoglycemia were assessed within one year after drug initiation. A Poisson model, built and developed based on DPP-4i users, was applied in SU users to estimate hypoglycemia rate if they had been switched to DPP-4i adjusting for patient demographics, comorbidities and medication use at baseline. Using National Health and Nutrition Examination Survey, the observed and predicted hypoglycemia costs were then projected on the national level for SU users, and the cost difference represented the change of total hypoglycemia costs had they switched to DPP-4 instead on the national level. Among patients who initiated SU (n=38,913) and DPP-4i (n=23,956), average age was 52 years; 44% were female. The observed hypoglycemia rates per 100-person years were 6.4 (95% CI: 6.0, 6.9) and 10.6 (95% CI: 10.1-11.1) in DPP-4i and SU groups, respectively. The predicted rate of hypoglycemia was 6.4 (95% CI: 6.1-6.8) in SU group had they switched to DPP-4i. At a national level, this switching could result in potential costs savings of $586 million (from $699 million to $113 million) within one year period. Our study suggests that switching patients from SU to DPP-4i could reduce hypoglycemia event rates by almost 40% and also result in substantial cost savings associated with hypoglycemia in the United States. Disclosure J. Liu: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Anthem, Inc.. Employee; Self; Janssen Scientific Affairs, LLC. Y. Tang: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Employee; Spouse/Partner; GlaxoSmithKline plc.. Stock/Shareholder; Spouse/Partner; GlaxoSmithKline plc. H. Hannachi: Employee; Self; Merck & Co., Inc. S.S. Engel: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Merck & Co., Inc..