Cost-effectiveness of dapagliflozin as a treatment for chronic kidney disease: a health-economic analysis of DAPA-CKD

McEwan, P., Darlington, O., Miller, R., McMurray, J. J.V. , Wheeler, D. C., Heerspink, H. J.L., Briggs, A. , Bergenheim, K. and Garcia Sanchez, J. J. (2022) Cost-effectiveness of dapagliflozin as a treatment for chronic kidney disease: a health-economic analysis of DAPA-CKD. Clinical Journal of the American Society of Nephrology, 17(12), pp. 1730-1741. (doi: 10.2215/CJN.03790322) (PMID:36323444)

Abstract

Background and objectives: CKD imposes a significant burden on patients and health care providers, particularly upon reaching kidney failure when patients may require KRT. The Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial demonstrated that dapagliflozin, with standard therapy, reduced CKD progression and KRT requirement. The study objective was to estimate the cost-effectiveness of dapagliflozin for the treatment of CKD from payer perspectives in the United Kingdom, Germany, and Spain. Design, setting, participants, & measurements: We constructed a lifetime Markov model to characterize outcomes in patients with CKD on the basis of the DAPA-CKD trial. Health states were defined by eGFR level and KRT type. Direct health care costs and utility values were sourced from published literature and the DAPA-CKD trial, respectively. Costs and benefits were discounted at 3.5% per annum in the United Kingdom and 3% in Germany and Spain. Results: In patients eligible for the DAPA-CKD trial, treatment with dapagliflozin was predicted to reduce rates of CKD progression, with patients predicted to spend 1.7 (95% credibility interval, 0.8 to 2.4) more years in the eGFR range 15–89 ml/min per 1.73 m2 versus standard therapy alone (12.1; 95% credibility interval, 8.9 to 14.1 versus 10.4; 95% credibility interval, 7.7 to 12.4 years). Life expectancy (undiscounted) was correspondingly predicted to increase by 1.7 (95% credibility interval, 0.7 to 2.5) years (15.5; 95% credibility interval, 11.1 to 18.2 versus 13.8; 95% credibility interval, 9.9 to 16.5 years). This in addition to reduced incidence of adverse clinical outcomes, including hospitalization for heart failure, resulted in modeled quality-adjusted life year (discounted) gains between 0.82 (95% credibility interval, 0.38 to 1.18) and 1.00 (95% credibility interval, 0.46 to 1.41). These gains translated to incremental cost-effectiveness ratios of $8280, $17,623, and $11,687 in the United Kingdom, Germany, and Spain, respectively, indicating cost-effectiveness at willingness-to-pay thresholds (United Kingdom: $27,510 per quality-adjusted life year; Germany and Spain: $35,503 per quality-adjusted life year). Conclusions: In patients meeting the eligibility requirements for the DAPA-CKD trial, dapagliflozin is likely to be a cost-effective treatment within the UK, German, and Spanish health care systems. Clinical Trial registry name and registration number: Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD), NCT03036150

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Briggs, Professor Andrew and McMurray, Professor John
• Authors: McEwan, P., Darlington, O., Miller, R., McMurray, J. J.V., Wheeler, D. C., Heerspink, H. J.L., Briggs, A., Bergenheim, K., and Garcia Sanchez, J. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Clinical Journal of the American Society of Nephrology
• Publisher: American Society of Nephrology
• ISSN: 1555-9041
• ISSN (Online): 1555-905X
• Published Online: 02 November 2022