Dapagliflozin in chronic kidney disease: cost-effectiveness beyond the DAPA-CKD trial
Phil McEwan, Jason A Davis, Peter D Gabb, David C Wheeler, Peter Rossing, Glenn M Chertow, Ricardo Correa-Rotter, Kouichi Tamura, Salvatore Barone, Juan Jose Garcia Sanchez- Transplantation
- Nephrology
Abstract
Introduction
The DAPA-CKD trial enrolled patients with estimated glomerular filtration rate 25–75 ml/min/1.73m2 and urine albumin-to-creatinine ratio >200 mg/g. The DECLARE-TIMI 58 trial enrolled patients with type 2 diabetes, a higher range of kidney function and no albuminuria criterion. The study objective was to estimate the cost-effectiveness of dapagliflozin in a broad chronic kidney disease population based on these two trials in the UK, Spain, Italy, and Japan.
Methods
We adapted a published Markov model based on the DAPA-CKD trial only to a broader population, irrespective of urine albumin-to-creatinine ratio, using patient-level data from the DAPA-CKD and DECLARE-TIMI 58 trials. We sourced cost and utility inputs from literature and the DAPA-CKD trial. The analysis considered healthcare system perspectives over a lifetime horizon.
Results
Treatment with dapagliflozin was predicted to attenuate disease progression and extend projected life expectancy by 0.64 years (12.5 versus 11.9 years, undiscounted) in the UK, with similar estimates in other settings. Clinical benefits translated to mean quality-adjusted life year (QALY; discounted) gains between 0.45–0.68 years across countries. Incremental cost-effectiveness ratios in the UK, Spain, Italy, and Japan (${\$}$10 676/QALY, ${\$}$14 479/QALY; ${\$}$7771/QALY, and ${\$}$13 723/QALY, respectively) were cost-effective at country-specific willingness-to-pay thresholds. Subgroup analyses suggest dapagliflozin is cost-effective irrespective of urinary albumin-to-creatine ratio and type 2 diabetes status.
Conclusion
Treatment with dapagliflozin may be cost-effective for patients across a wider spectrum of estimated glomerular filtration rates and albuminuria than previously demonstrated, with or without type 2 diabetes, in the UK, Spanish, Italian and Japanese healthcare systems.