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. 2022 Oct;37(13):3380-3387.
doi: 10.1007/s11606-021-07311-5. Epub 2022 Feb 8.

Cost-Effectiveness of Dapagliflozin for Non-diabetic Chronic Kidney Disease

Rebecca L Tisdale  1   2 , Marika M Cusick  3 , Kelly Zhang Aluri  4   5 , Thomas J Handley  3   6   7 , Alice Kate Cummings Joyner  8 , Joshua A Salomon  3 , Glenn M Chertow  3   4   9 , Jeremy D Goldhaber-Fiebert  3 , Douglas K Owens  3
Affiliations

Cost-Effectiveness of Dapagliflozin for Non-diabetic Chronic Kidney Disease

Rebecca L Tisdale et al. J Gen Intern Med. 2022 Oct.

Abstract

Background: In the USA, chronic kidney disease (CKD) affects 1 in 7 adults and costs $100 billion annually. The DAPA-CKD trial found dapagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, to be effective in reducing CKD progression and mortality in patients with diabetic and non-diabetic CKD. Currently, SGLT2 inhibitors are not considered standard of care for patients with non-diabetic CKD.

Objective: Determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic CKD.

Design: Markov model with lifetime time horizon and US healthcare sector perspective.

Patients: Patients with non-diabetic CKD INTERVENTION: Dapagliflozin plus standard care versus standard care only.

Main measures: Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually; total incidence of kidney failure on kidney replacement therapy; average years on kidney replacement therapy.

Key results: Adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted QALYS (from 6.75 to 8.06), and reduced the total incidence of kidney failure on kidney replacement therapy (KRT) (from 17.4 to 11.0%) and average years on KRT (from 0.77 to 0.43) over the lifetime of the cohort. Dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs (from $245,900 to $324,8900, or $60,000 per QALY gained). Results were robust to variations in assumptions about dapagliflozin's efficacy over time and by CKD stage, added costs of kidney replacement therapy, and expected population annual CKD progression rates and sensitive to the cost of dapagliflozin. The net 1-year budgetary implication of treating all US patients with non-diabetic CKD could be up to $21 billion.

Conclusions: Dapagliflozin improved life expectancy and reduced progression of CKD, the proportion of patients requiring kidney replacement therapy, and time on kidney replacement therapy in patients with non-diabetic CKD. Use of dapagliflozin meets conventional criteria for cost-effectiveness.

Keywords: chronic kidney disease; cost-effectiveness analysis; health economics.

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Conflict of interest statement

Dr. Chertow served on the Steering Committee of the DAPA-CKD trial. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Schematic diagram of the CKD Markov Model.
Figure 2
Figure 2
Total incidence of kidney failure requiring kidney replacement therapy (KRT), standard of care versus dapagliflozin plus standard of care.
Figure 3
Figure 3
Dapagliflozin cost-effectiveness by age and CKD stage. *ICER = incremental cost-effectiveness ratio; negative ICERs indicate cost-saving results.
Figure 4
Figure 4
One-way sensitivity analysis tornado plot (base case). *Results with all tested parameters are included in the Supplement.
See this image and copyright information in PMC

References

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