Cost-Effectiveness of Dapagliflozin in the Treatment of Patients With Chronic Kidney Disease in Denmark

Le résumé fourni par la source

Rationale & Objective Chronic kidney disease (CKD) is a growing burden worldwide and in Denmark, with substantial clinical and economic consequences. Although national guidelines recommend sodium-glucose transporter-2 inhibitors (SGLT2i) for patients with CKD, type 2 diabetes (T2D) or heart failure (HF), underdiagnosis limits the use of SGLT2i. This study aims to inform decision-makers in healthcare about the cost-effectiveness of current guidelines for CKD in Denmark focusing on SGLT2i dapagliflozin added to standard of care (SoC) versus SoC alone in patients with CKD. Study Design Cost-effectiveness analysis based on a Markov model with a lifetime horizon. Setting & Participants Danish healthcare payer perspective including a broad population with CKD and subgroups stratified by urinary albumin-to-creatine ratio (UACR), T2D status, and HF history. Exposures Dapagliflozin plus SoC versus SoC alone. Outcomes Quality-adjusted life years (QALYs), life-years, total costs, and incremental cost-effectiveness ratios (ICERs). Analytical Approach A published Markov model was populated using data from the DAPA-CKD and DECLARE-TIMI 58 trials. Analyses were conducted for the overall population and stratified subgroups. Results were evaluated against an assumed willingness-to-pay (WTP) threshold of €24,158 per QALY. Results Dapagliflozin-treatment resulted in health benefits (QALYs), life-years) versus SoC irrespective of T2D/HF status or UACR levels. Dapagliflozin was cost-effective for the total population with an ICER of €7,499/QALY, and dominant for subgroups with high UACR (≥200 mg/g) regardless of T2D/HF status. ICERs were below WTP threshold for all subgroups, however, for patients with CKD and low UACR (<200 mg/g) without T2D/HF, time to cost-effectiveness was long and estimates were uncertain. Limitations Results are limited by generalizability, long-term uncertainty, simulated subgroup data, cost uncertainty, and lack of a Danish WTP threshold. Conclusions This study indicates that dapagliflozin added to SoC is cost-effective across CKD subgroups as recommended in the current Danish guideline recommendations.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.