Clinical-economic assessment of the potential contribution of evogliptin to achieving the targets of the Federal project «Fight against diabetes mellitus» and reduction of population mortality

Background. Since 2023, Russia has been implementing the Federal Project "Fight against diabetes mellitus" with a key objective of increasing the proportion of patients achieving a glycated hemoglobin (HbA_1c) level below 7.0 %.

The aim of this study was to evaluate the contribution of expanding the use of dipeptidyl peptidase-4 inhibitors (iDPP-4) (in the example of evogliptin) in achieving the targets of the Federal Project "Fight against diabetes mellitus" and reduce mortality, as well as the budget impact analysis of such policies.

Materials and methods. The target population of the study were adult patients with diabetes mellitus type 2 (DM2) whose HbA_1c levels ranged from 7.1 % to 9.0 % while on glucose-lowering therapy with metformin (MET), sulfonylureas, or their combinations, and with the absence of significant comorbidities (e. g., ischemic heart disease, cerebrovascular diseases, myocardial infarction, or diabetic nephropathy). We also included patients receiving a combination of MET and Sodium-Glucose Transport Protein 2 inhibitors. To assess the change in HbA_1c levels when evogliptin is included in the treatment regimen, a mathematical model was developed based on data from the Federal register of diabetes mellitus, clinical studies on the use of iDPP-4, and expert consultations. To model mortality, we incorporated evidence from meta-analyses demonstrating that exceeding target HbA_1c levels are associated with higher mortality. Only the costs of antidiabetic therapy were considered expenses. The budget impact was defined as the difference between the costs within the current treatment practices for DM2 in the study patient cohort and the expected expenses when modifying the therapeutic approach.

Results. The target population of patients who can be prescribed evogliptin in addition to existing hypoglycemic therapy is 937,225 people. Expanding the use of evogliptin in patients from the target population can reduce mortality by 851 cases in the first year and save up to 4,275 lives of patients with type 2 diabetes over a 5-year horizon. In addition, this will allow us to exceed the goal of the Federal Project "Fight against diabetes" within one year for the proportion of patients with diabetes with a glycated hemoglobin level of 7 % or less, increasing the figure to 52 % (with a target value of 42.39 %).

Conclusion. Expanding the use of evogliptin in patients with type 2 diabetes will help achieve the target indicators of the Federal Program "Fight against diabetes mellitus" and reducing population mortality.

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