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

Rebecca L Tisdale; Marika M Cusick; Kelly Zhang Aluri; Thomas J Handley; Alice Kate Cummings Joyner; Joshua A Salomon; Glenn M Chertow; Jeremy D Goldhaber-Fiebert; Douglas K Owens

doi:10.1007/s11606-021-07311-5

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

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

Authors

Rebecca L Tisdale^{1

2}, Marika M Cusick³, Kelly Zhang Aluri^{4

5}, Thomas J Handley^{3

6

7}, Alice Kate Cummings Joyner⁸, Joshua A Salomon³, Glenn M Chertow^{3

4

9}, Jeremy D Goldhaber-Fiebert³, Douglas K Owens³

Affiliations

¹ VA Palo Alto Health Care System (152-MPD), Health Services Research and Development (HSR&D), Center for Innovation to Implementation (Ci2i), 795 Willow Road, Building 324, Menlo Park, CA, 94025, USA. rtisdale@stanford.edu.
² Department of Health Policy, School of Medicine, and Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA. rtisdale@stanford.edu.
³ Department of Health Policy, School of Medicine, and Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.
⁴ Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Stanford University School of Medicine, Stanford, CA, USA.
⁶ Department of Surgery and Cancer, Imperial College London, London, UK.
⁷ Stanford-Surgery Policy Improvement Research & Education (S-SPIRE) Center, Stanford, CA, USA.
⁸ Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
⁹ Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

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.

Publication types

Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Adult
Benzhydryl Compounds
Cost-Benefit Analysis
Diabetes Mellitus, Type 2* / drug therapy
Glucose
Glucosides
Humans
Quality-Adjusted Life Years
Renal Insufficiency, Chronic* / drug therapy
Renal Insufficiency, Chronic* / epidemiology
Sodium
Sodium-Glucose Transporter 2
Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use

Substances

Benzhydryl Compounds
Glucosides
Sodium-Glucose Transporter 2
Sodium-Glucose Transporter 2 Inhibitors
dapagliflozin
Sodium
Glucose

Abstract

Publication types

MeSH terms

Substances

Grants and funding