Cost–Utility Analysis of Dapagliflozin as an Add-on to Standard of Care for Patients with Chronic Kidney Disease in Thailand

Abstract

Introduction: Chronic kidney disease (CKD) creates a significant economic burden on patients and society. The DAPA-CKD trial reports the benefit of dapagliflozin in CKD patients; however, its cost-effectiveness is unknown in Thailand. This study evaluated the cost-utility of dapagliflozin in addition to standard of care (SoC) compared with SoC alone in CKD patients. Methods: A Markov model was employed to estimate lifetime costs, life-years, and qualityadjusted life-year (QALY), with the modeled population aligned to the baseline characteristics of a DAPA-CKD trial, from a societal perspective. Effectiveness inputs were obtained from the DAPA-CKD trial. Costs and most utility data were gathered from published studies conducted in Thailand. Costs and benefits were discounted at 3% per annum. A series of sensitivity analyses were performed. Results: Over a lifetime horizon, add-on dapagliflozin was estimated to increase life-years by 0.34 and QALY by 0.30 in comparison with SoC alone (7.13 vs. 6.78 years, 5.10 vs. 4.80 QALYs). Total cost was lower under dapagliflozin treatment than SoC treatment (648,413 THB vs. 689,284 THB or 20,947.64 USD vs. 22,268.01 USD). Cost saving occurred as a result of the lower costs of dialysis and KT. The findings were robust to the changes of inputs. Conclusions: On the basis of the DAPA-CKD trial, the add-on dapagliflozin results in cost saving compared favorably with SoC alone in Thailand. The benefit of dapagliflozin in delayed CKD progression is that it reduces the requirement for dialysis and KT, which can offset the costs of dapagliflozin and early CKD treatment.

Cost-Effectiveness of Dapagliflozin for Chronic Kidney Disease in Japan

“…11 In previous studies in other countries, SGLT2 inhibitors were cost-effective for CKD. [21][22][23] Consistent with those previous studies, the cost-effectiveness of SGLT2 inhibitors for CKD stage3b is considered to be acceptable in Japan. However, there are some differences between CKD stage 3a and stage 3b.…”

“…18-20 Although there have been cost-effectiveness studies on SGLT2 inhibitors for CKD with and without diabetes mellitus in various countries, none has examined the cost-effectiveness of SGLT2 inhibitors for CKD in Japan. [21][22][23] The frequency of cardiovascular and renal events differs between the USA, Asian countries and Japan, and the medical systems also I n recent years, the number of patients with heart failure (HF) has rapidly increased in Japan as the number of older people has increased, and is termed a "heart failure pandemic". 1 Chronic kidney disease (CKD) is an important risk factor for HF, 2 so its treatment should curb the increase in patients with HF.Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been reported to be useful for treating CKD, 3 although they were originally developed as drugs that lower blood glucose concentrations by inhibiting glucose reabsorption in the renal proximal tubule.…”

Cost-Effectiveness of Dapagliflozin as a Treatment for Chronic Kidney Disease

“…Empagliflozin has also demonstrated cost-effectiveness in an analysis of patient-level data from the BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) trial conducted in patients with diabetic kidney disease (22). Hence, treatment of CKD with dapagliflozin represents a good use of health care resources if adopted into clinical practice in Germany, Spain, and the United Kingdom, in line with recent published analyses in Thailand and the United States (21,23).…”

Cost‐effectiveness of canagliflozin and dapagliflozin for treatment of patients with chronic kidney disease and type 2 diabetes

“…There is limited evidence on the cost‐effectiveness of canagliflozin + SoC, dapagliflozin + SoC, and SoC alone for treatment of CKD and T2D. Most previous studies have examined the cost‐effectiveness of these treatments for patients with either CKD or T2D 9–11 . To the extent that patients with both CKD and T2D face higher risks of CV and renal events as well as have higher healthcare costs than those with CKD or T2D, these studies are unable to shed light on the cost‐effectiveness of these treatments for the group of patients with both CKD and T2D.…”

“…Most previous studies have examined the cost-effectiveness of these treatments for patients with either CKD or T2D. [9][10][11] To the extent that patients with both CKD and T2D face higher risks of CV and renal events as well as have higher healthcare costs than those with CKD or T2D, these studies are unable to shed light on the cost-effectiveness of these treatments for the group of patients with both CKD and T2D. Only one study showed that canagliflozin + SoC was less costly and more effective than SoC alone in patients with CKD and T2D.…”