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

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, 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.