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. 2021 Mar 18;2(6):1031-1035.
doi: 10.34067/KID.0000742021. eCollection 2021 Jun 24.

Payment, Coverage, and Health Economics of SGLT2 Inhibitors

Ngoc-Yen T Pham  1 , Christos P Argyropoulos  2 , Sireesha Koppula  2
Affiliations

Payment, Coverage, and Health Economics of SGLT2 Inhibitors

Ngoc-Yen T Pham et al. Kidney360. .
No abstract available

Keywords: chronic kidney disease; coverage; diabetic kidney disease; health economics; sodium glucose cotransporter two inhibitors.

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Conflict of interest statement

C. Argyropoulos reports having consultancy agreements with Momenta Pharma; reports receiving research funding from Dialysis Clinic, Incorporated, University of Pennsylvania; reports being a scientific advisor or member of Baxter Healthcare, Health Services Advisory Group, and Bayer; and reports other interests/relationships as Medical Director—Outpatient Dialysis Unit of Dialysis Clinic, Incorporated in Cuba, New Mexico, site Principal Investigator in two phase 3 trials of an investigational product for the correction and maintenance of anemia in patients with nondialysis-dependent CKD and one phase 3 study of the same agent in dialysis at Akebia, site sub-investigator in a phase 3 study of an experimental agent in diabetic nephropathy at AbbVie, and site Principal Investigator for CKD Outcomes and Practice Patterns Study. All remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
Net savings (per patient, as a fraction of annual drug cost) associated with the use of SGLT2i as a function of baseline risk (event rate per 1000 years) and the cost of treating a complication (also as a ratio of the annual drug cost). The net saving is the difference between treating the complication (e.g., cost of renal replacement) minus the drug expenditure. Net cost can be negative, indicating an unfavorable value proposition for SGLT2i. To construct the graph, we assumed a hazard ratio of 0.66 (the average hazard ratio seen in CREDENCE and DAPA-CKD 95% CI, 0.56 to 0.79) and the USRDS RRT cost, which includes costs for both dialysis and transplant as previously reported. Negative net savings (the white area in the plot) represents increased expenditures under universal adoption of these drugs. USRDS RRT cost set to US$104,932 used by the CREDENCE cost model (9), and annual drug costs set to US$6000/yr, which is the Part D cost of an SGLT2i inhibitor with a cardiorenal indication (11). Horizontal grid lines mark the event rates of the placebo arm in CREDENCE (17.7 events per 1000 patient years) and RENAAL (91 events per 1000 patient years), and vertical grid lines different scenarios of the cost of treating a complication over the annual drug cost: x1, x4, x8 multiples of the cost of RRT/current annual drug cost to Part D for an SGLT2i with a cardiorenal indication As can be seen from the figure, the current drug prices (left vertical line) intersects with the baseline rates in CREDENCE (or even RENAAL) in an area of the figure associated with increased total costs. Thus, wide adoption of SGLT2i, as currently priced, will not result in net cost savings, despite their overwhelming clinical benefit. SGLT2i, sodium glucose cotransporter two inhibitors; CREDENCE, Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation; DAPA-CKD, Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease; RENAAL, Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan; USRDS, United States Renal Data System.
See this image and copyright information in PMC

References

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