Empagliflozin versus Canagliflozin for Prevention of Heart Failure in Patients With Type Two Diabetes

Joseph Azuri, Ariel Hammerman, Enis Aboalhasan, Ronen Arbel

Keywords: empagliflozin, canagliflozin, heart failure, diabetes


The sodium glucose cotransporter 2 inhibitors (SGLT2i) empagliflozin and canagliflozin have proven efficacy in reducing the risk of hospitalization for heart failure (HHF) or cardiovascular mortality in patients with Type 2 diabetes mellitus (T2D). The addition of SGLT2i to the standard of care may impose a significant burden to the healthcare system.

Research questions:

To determine the cost saving strategy between Empagliflozin and Canagliflozin for prevention of HHF and cardiovascular mortality in patients with HF and T2D.


We calculated the cost needed to prevent one event of HHF or cardiovascular mortality, by multiplying the one-year number needed to treat (NNT) to prevent one event, by the annual therapy cost. Efficacy estimates was extracted from published RCT data. Sensitivity, scenario and subgroup analyses were performed to mitigate differences and uncertainties in the trials. Drug costs were based on the 2019 US National Average Drug Acquisition Cost prices.


The cost needed to to prevent one event of HHF or CV mortality with empagliflozin is $529,828 ($391,612-$835,055) compared to $1,206,348 (95% CI: $787,930-$2,912,624) with canagliflozin. In all the scenario and sensitivity analyses performed, empagliflozin was consistently a significant cost-saving strategy compared to canagliflozin, except for the sub-group of patients with prior history of HF.


Empagliflozin prescribed for preventing CV death or HHF in type 2 diabetes patients seems to be a major cost-saving strategy compared to canagliflozin for the same purpose. Canagliflozin may be used primarily for patients with prior history of HF.

Points for discussion:

How should the clinician consider medical treatment in an era of financial constraints ?

How important are financial issues and drug costs in clinical decision making ?