# Kosteneffectiviteit van SGLT2-remmers en GLP-1-agonisten bij hoog cardiovasculair risico in Canada

*geplaatst 2026-02-22 · Preventie · CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · doi 10.1503/cmaj.250591 · https://hartvaat.nl/2026/02/22/kosteneffectiviteit-van-sglt2-remmers-en-glp-1-agonisten-bij-hoog-cardiovasculai/*

Een Canadese simulatiestudie vergeleek SGLT2-remmers met GLP-1-receptoragonisten bij patiënten met diabetes type 2 en hoog cardiovasculair risico. SGLT2-remmers leverden meer kwaliteitsjaren op tegen lagere kosten ($21.400 per QALY) en waren consistent kosteneffectief. GLP-1-agonisten werden in 62% van de analyses gedomineerd.

## English: Cost-effectiveness of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists for patients with high cardiovascular risk and type 2 diabetes in Canada.

This Canadian simulation study compared the cost-effectiveness of SGLT2 inhibitors versus GLP-1 receptor agonists in type 2 diabetes with high cardiovascular risk, informing formulary and reimbursement decisions for cardiometabolic therapy.

## Abstract (original, from the publication)

BACKGROUND: Diabetes Canada and the Canadian Cardiovascular Society recommend that patients with type 2 diabetes and cardiovascular disease, renal disease, or multiple cardiovascular risk factors begin glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter 2 inhibitors (SGLT2i). We assessed cost-effectiveness in patients meeting these criteria in Canada. METHODS: Our patient-level simulation estimated lifetime costs, clinical events, and quality-adjusted life-years (QALYs) for patients initiating SGLT2i or GLP-1 RA or remaining on "baseline treatment"; i.e., other standard-of-care medications. We based initial laboratory values and characteristics on 216 patients from a Quebec clinic focused on initiating guideline-directed diabetes therapies from 2022 to 2025. We calibrated risk equations and treatment effects to end points from placebo-controlled cardiovascular outcome trials. We estimated cost-effectiveness over a patient lifetime horizon from a Canadian health care payer perspective using a 1.5% annual discount rate. We performed probabilistic sensitivity analysis. RESULTS: Compared with baseline treatment, SGLT2i and GLP-1 RA reduced lifetime rates of cardiovascular and renal events and produced higher net present QALYs (+0.24 SGLT2i; +0.23 GLP-1 RA ), but at a higher net present cost (+$5000 SGLT2i; +$27 000 GLP-1 RA [2023 Canadian $]). Sodium-glucose cotransporter 2 inhibitors cost $21 400 per QALY gained and were consistently cost-effective in sensitivity analyses. In 62% of probabilistic sensitivity analysis iterations, GLP-1 RA were dominated, producing fewer QALYs at a higher cost than SGLT2i. INTERPRETATION: Sodium-glucose cotransporter 2 inhibitors provided more QALYs at a lower price than GLP-1 RA and were cost-effective at current prices. Glucagon-like peptide-1 RA cost-effectiveness may improve if outcomes beyond typical diabetes complications are considered and if generic GLP-1 RA become available.

Auteurs: Ethan S McNally, Pedro Marques, Elite Possik, Ankur Pandya, Michael A Tsoukas, Thomas A Mavrakanas, Kaberi Dasgupta, Nisha Gupta, Abhinav Sharma, W Alton Russell

---
Bron: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, https://doi.org/10.1503/cmaj.250591. Bijgewerkt 2026-07-03T13:24:32Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.