Lexicon Pharmaceuticals, Inc. recently announced that the Journal of Managed Care + Specialty Pharmacy—the peer-reviewed journal of the Academy of Managed Care Pharmacy—published a research paper concluding that prescribing Inpefa (sotagliflozin) for the treatment of patients hospitalized for heart failure (HF) and suffering from comorbid diabetes results in significant positive impact on health system provider financial outcomes, principally due to bonus payments through alternative payment models (APMs). The new analysis of the pivotal phase III SOLOIST-WHF trial provides additional evidence of positive economic impact on hospitals participating in various APMs.

These findings are consistent with two peer-reviewed studies published in June 2024, “Cost-effectiveness of Sotagliflozin in SOLOIST-WHF” in the Journal of the American College of Cardiology: Heart Failure and “Cost-effectiveness of sotagliflozin for the treatment of patients with diabetes and recent worsening heart failure” in the Journal of Comparative Effectiveness Research.

For this new analysis, researchers calculated the 1-year financial impact on U.S. health system providers of adopting sotagliflozin relative to standard of care (SoC) across three common APMs, also known as value-based purchasing agreements: the Bundled Payments for Care Improvement-Advanced program (BPCI), Medicare Shared Savings Program for Accountable Care Organizations program (ACO), and the Hospital Readmissions Reduction Program (HRRP). HRRP is a Medicare value-based purchasing program intended to encourage hospitals to diminish the 30-day risk of unplanned readmissions for six procedures or conditions, including HF.

Jason Shafrin, PhD, Center for Healthcare Economics and Policy at FTI Consulting, and the lead author of the research paper, stated, “Our analysis demonstrated that sotagliflozin use reduced the frequency of patient hospital readmissions and emergency department visits, leading providers to receive larger value-based bonus payments under these alternative payment models.”

The study population matched that of the SOLOIST-WHF trial: adult patients aged 18 to 85 years who had been hospitalized for an HF event and were also diagnosed with diabetes. The researchers modeled the total costs of rehospitalization, emergency department visits, drug costs, and adverse events between sotagliflozin and SoC from the perspective of a median-sized U.S. community hospital and concluded that substantial positive financial impacts were attained with sotagliflozin when participating in any of the three studied APMs. On a per-admission basis, sotagliflozin adoption resulted in a $4,720 margin increase for HRRP, a $1,200 margin increase for BPCI, and a $1,078 margin increase for ACO.

Sotagliflozin implementation also generated noteworthy cost savings when measured on a total health system basis. The model estimated that a median-sized U.S. community hospital would realize a $305,604 annual margin increase for HRRP, a $100,106 margin increase for BPCI, and a $31,029 margin increase for ACO by adopting sotagliflozin.

“There is a growing body of evidence that the use of INPEFA for patients hospitalized with heart failure who suffer from diabetes leads to significant value for payors and clinical institutions,” stated Craig Granowitz, MD, PhD, Lexicon’s senior VP and CMO. “This analysis provides additional evidence that as more health systems adopt APMs, often more than one at a time, there is potential to realize important clinical and financial advantages with the use of INPEFA.”

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