Key result
Sotagliflozin increased annual per-user costs by $4,996 in an all-payer plan, as higher pharmacy costs were partially offset by a $2,608 reduction in medical costs from fewer rehospitalizations and ED visits.
Why the study?
Although sotagliflozin reduced rehospitalizations in patients with HF and diabetes in the SOLOIST-WHF trial, its economic impact from a US payer perspective remained unclear.
Does the addition of sotagliflozin to standard of care for patients recently hospitalized for heart failure with comorbid type 2 diabetes result in a favorable budget impact for US payers?
Does the addition of sotagliflozin to standard of care for patients recently hospitalized for heart failure with comorbid type 2 diabetes result in a favorable budget impact for US payers?
In a US payer budget impact model, adding sotagliflozin for patients recently hospitalized for heart failure with type 2 diabetes increased pharmacy costs, but 21%-68% of these costs were offset by reduced rehospitalizations and emergency department visits.
BACKGROUND: Heart failure (HF) is a leading cause of mortality in the United States, often complicated by comorbidities like diabetes mellitus. These patients face high hospitalization risks, impacting clinical outcomes and health care resources. The Effect of Sotagliflozin on Cardiovascular Events in Patients with Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial showed that sotagliflozin, a sodium-glucose cotransporter inhibitor, reduced rehospitalizations in patients with HF and diabetes mellitus. Although clinically beneficial, the economic impact of sotagliflozin from a payer perspective remains unclear, warranting further pharmacoeconomic analysis to guide managed care decisions. OBJECTIVE: To quantify the budget impact of sotagliflozin for US payers over a 5-year time horizon. METHODS: A payer-perspective budget impact model was developed to assess the financial impact of incorporating sotagliflozin for the treatment of patients recently hospitalized for HF with comorbid type 2 diabetes (T2D) over 5 years to US payer health plans. The study used a population reflecting the SOLOIST-WHF clinical trial, with economic parameters adjusted by payer mix (all payer, commercial, Medicare, and Medicaid). Health care resource utilization included hospitalization, emergency department (ED) visit, and adverse events' care. Economic outcomes examined the medical and pharmacy budget impact for payers at the per-user, per member per month (PMPM), and total plan costs levels. RESULTS: For a hypothetical 1-million-member all-payer plan, 1,516 patients hospitalized for HF with comorbid T2D would be eligible for sotagliflozin. For all-payer plans, annual per-user costs increased by $4,996 because of higher pharmacy costs ($8,260) but were partially offset by lower medical costs (-$2,608) because of reduced rehospitalization and ED visits from sotagliflozin. PMPM total budget impact of sotagliflozin would be $0.08 PMPM in year 1 and $0.38 in year 5, corresponding with total plan cost of $75,736 in year 1 and $378,681 by year 5. Commercial payer PMPM costs were lower ($0.02 in year 1; $0.11 in year 5), and higher for Medicare ($0.23 PMPM in year 1, increasing to 1.13 PMPM in year 5). Breakeven rebate rates ranged between 31.5% and 79.4%. CONCLUSIONS: Although sotagliflozin increases pharmacy costs for recently hospitalized HF patients with T2D, approximately 21%-68% of pharmacy costs were offset from reduced rehospitalization and ED visits.
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Shafrin et al. (2025) studied Heart failure with comorbid type 2 diabetes (n=1,000,000). Sotagliflozin vs. Standard of care was evaluated on Annual per-user total costs (all-payer). Sotagliflozin increased annual per-user costs by $4,996 in an all-payer plan, as higher pharmacy costs were partially offset by a $2,608 reduction in medical costs from fewer rehospitalizations and ED visits.
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