The ADVI Health Strategic Analytics, Value, and Economics (SAVEs) team worked with a US-based biopharmaceutical company to perform a cohort study aimed to examine inequalities in the usage of SGLT-2 inhibitors among Medicare patients with type 2 diabetes (T2D) based on demographic and socioeconomic factors and their impact on overall Medicare spending. The study analyzed data from T2D patients with cardiovascular-related disease who received outpatient care using the Medicare Fee-for-service (FFS) Research Identifiable Files.

Results from the study showed that Black T2D patients had lower rates of SGLT-2 inhibitor use compared to White T2D patients. Factors such as female gender and receiving low-income subsidies were also associated with lower rates of usage.

The study suggests that expanding the use of SGLT-2 inhibitors in this population, particularly among Black females and low-income patients, could significantly improve cardiovascular outcomes.

The Challenge

Despite the proven benefits of SGLT-2 inhibitors in reducing hospitalizations and mortality among patients with T2D and major cardiovascular outcomes, there is a significant disparity in the usage of these medications among Medicare patients. Understanding the demographic and socioeconomic factors that contribute to this disparity is crucial in improving overall Medicare spending and cardiovascular outcomes for these patient populations. The pharmaceutical company may face challenges in developing and implementing effective strategies to increase SGLT-2 inhibitor usage in these underrepresented populations.

The Strategy

Through ADVI SAVEs’ access to the 100 percent Medicare FFS claims data, we were able to conduct a retrospective cohort study of 3,582,770 T2D patients with cardiovascular-related diseases who received outpatient care from January 2017 to August 2021. Results showed that Black T2D patients had a lower SGLT-2 inhibitor usage rate compared to their White counterparts (3.4 percent vs 5.2 percent). Additionally, being female and receiving low-income subsidies were associated with lower rates of SGLT-2 inhibitor use. Multivariate regression analyses showed that Black race, female gender, and low-income subsidy were all independently associated with lower rates of SGLT-2 inhibitor use. On average, Black patients received $69 less in Medicare spending compared to non-Black patients. These findings suggest a need to expand the use of SGLT-2 inhibitors, particularly among Black females and low-income patients, to improve cardiovascular outcomes.

The Results

ADVI SAVEs assessment highlights the disparities in SGLT-2 inhibitor usage rates among Medicare patients with T2D and major cardiovascular outcomes. The findings can help inform targeted interventions to improve SGLT-2 inhibitor usage among these patient populations, which could significantly improve cardiovascular outcomes. Moreover, the study underscores the need for policies and programs aimed at reducing healthcare disparities and increasing equitable access to life-saving treatments.