Modelled CKD benefits of broad SGLT-2i eligibility in the UK

Introduction: Chronic kidney disease (CKD) affects more than 10% of the United Kingdom (UK) population and is expected to rise.Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are effective at slowing CKD progression; however, they are under prescribed due to barriers including the need for urine albumin-creatinine ratio (UACR) testing and lack of guideline alignment.This study sought to quantify the clinical, economic, and environmental trade-offs of broad and restrictive SGLT-2i access in the UK. Methods:Five scenarios exploring a range of SGLT-2i eligibility criteria for patients with CKD were modelled over 10 years, beginning from 2025, using the validated IMPACT CKD individual-level microsimulation model.SGLT-2i treatment was modelled to improve estimated glomerular filtration rate decline and reduce cardiovascular events and acute kidney injury.A 3.5% per annum discount was applied to economic outcomes. Results:A maximally inclusive SGLT-2i scenario was compared to each of the less inclusive SGLT-2i eligibility criteria scenarios.Increasingly restrictive scenarios are projected to increase dialysis and allcause mortality by 4.0%-17.2%and 1.3%-4.3%,respectively.Resulting from higher mortality, CKD prevalence is projected to decrease by 0.5%-1.4%.Non-kidney replacement therapy (KRT) CKD costs and KRT costs are projected to increase by 0.7%-2.1% and 2.4%-10.6%,respectively with increasingly restrictive scenarios.Total costs are projected to decrease by 15.2%-33.9%as fewer patients are treated.Due to shifts to later stages, KRT-related environmental burden is projected to increase by 3.1%-14.9%. Conclusion:Broad SGLT-2i eligibility criteria would likely reduce the holistic burden of CKD for patients, the National Health Service, and the environment.