AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Health Economic Value of Reducing Initiation Delays of Guideline-Directed Therapies for Improving Cardiovascular and Renal Outcomes for Complex Patients with Type 2 Diabetes
By McNally E, Sharma A, Marques P et al.
Introduction: SGLT2i and GLP-1 RA are recommended for patients with type 2 diabetes and high cardiorenal risk in Canada but remain underutilized in eligible populations. Programs aimed at initiating these therapies (e.g., synchronized multidisciplinary clinics) have been developed to increase uptake and reduce treatment delays. We estimated the maximum per patient implementation cost at which such programs would be cost-effective from a Canadian healthcare payer’s perspective at expected generic GLP-1 RA prices. Methods: We adapted an existing simulation model to estimate diabetes complications, costs (2023 CAD), and quality adjusted life years (QALYs) over a lifetime horizon, discounted at 1.5%. Our cohort included 127 SGLT2i and GLP-1 RA naive patients with type 2 diabetes whose characteristics were based on patients seen at a synchronized multidisciplinary clinic in Montreal. The annual cost of SGLT2i ($762) was estimated from the Quebec provincial formulary. Generic semaglutide, a GLP-1 RA, has recently become available in Canada. Formulary prices are not yet known so we modelled GLP-1 RA priced at $75 per month ($900 annually) and $100 per month ($1,200 annually) based on recently reported estimates. We assumed that an initiation program would lead to immediate initiation of SGLT2i, GLP-1 RA or both therapies. The counterfactual “status quo” was that initiation would be 1) delayed (by 1-3 years) or 2) never occur without the initiation program (counterfactual initiation rates of 25-100%). We present a two-way table of the incremental net monetary benefit: the difference in QALYs times the willingness to pay ($50,000/QALY) minus the difference in costs between the initiation program and the counterfactual. This is the maximum lifetime per patient cost for the program to be cost-effective for a given treatment delay and counterfactual initiation rate. Results: We estimated that programs that initiate SGLT2i with an implementation cost of up to $540-$3,350 per patient were cost-effective depending on the counterfactual (Figure). At a GLP-1 RA price of $75 per month, immediate GLP-1 RA and dual therapy initiation were predicted to be cost-effective for all modelled counterfactual scenarios (iNMB>0). Within most counterfactual scenarios, dual therapy was predicted to have the highest per-patient cost threshold to be cost-effective compared to SGLT2i or GLP-1 RA alone. At a GLP-1 RA price of $100 per month, immediate GLP-1 RA initiation was predicted to be cost-effective only for counterfactual scenarios where patients would eventually initiate, irrespective of the intervention. For this comparison, the intervention would need to cost less than between $135 and $225 per patient to be cost-effective. Conclusion: Our results support the implementation of programs or policies aimed at initiating SGLT2i and GLP-1 RA/dual therapy once generic GLP-1 RA become widely available in Canada.