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August 15, 2026PharmacoEconomics - OpenOpen Access

Adding SGLT2 inhibitors to optimized CVD treatment costs ~$80,000 per QALY gained vs treatment alone.

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Why the study?

Most US adults with CKD are unaware until later stages, prompting the need for a policy model providing contemporary estimates of long-term effectiveness and cost-effectiveness of medical interventions.

Does cardiovascular treatment optimization and SGLT2 inhibitor therapy improve cost-effectiveness and clinical outcomes in US adults with chronic kidney disease?

Population

Hypothetical cohort of insured US adults with CKD

Comparison

Fully optimized treatment with no delay to initiation vs usual care

Design

State transition simulation model

Follow-up

Lifetime

Key result

Guideline-optimized cardiovascular treatment combined with SGLT2 inhibitor therapy improved patient outcomes with an incremental cost-effectiveness ratio of $80,008 per QALY gained compared to optimized treatment alone.

Authors

ABAndrew BriggsCKCiaran Kohli‐LynchALAdrian R. Levy

Discussion

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Overview

Modeled QALY gains from optimized CKD care should not yet change practice; leaves open prospective validation of this policy model.

Key Points

  • To describe the structure of a policy model for chronic kidney disease and quantify the lifetime clinical effectiveness and cost-effectiveness of guideline-optimized management strategies.
  • Developed a state transition model tracking a hypothetical cohort of insured US adults with chronic kidney disease through KDIGO categories over a lifetime horizon.
  • Simulated transitions to end-stage renal disease, cardiovascular disease, heart failure, or non-CKD death using parameters derived from peer-reviewed literature and claims data covering over 100 million adults.
  • Under usual care, 15% of patients experienced a non-CKD death as their first event at an average of 12 years, increasing to 20% at an average of 14 years with immediate, fully optimized treatment.
  • Guideline-optimized treatment without initiation delay gained 0.68 quality-adjusted life years (QALYs) over a patient lifetime at an incremental cost of US $47,800.

Structured PICO

Does cardiovascular treatment optimization and SGLT2 inhibitor therapy improve cost-effectiveness and clinical outcomes in US adults with chronic kidney disease?

P
Population
100,000 hypothetical US adults with chronic kidney disease, mean age 57.9 years, simulated over a lifetime horizon to evaluate cardiovascular treatment optimization and SGLT2 inhibitor therapy.
I
Intervention
Cardiovascular disease (CVD) treatment optimization (statin therapy for all, blood pressure medication for untreated or uncontrolled hypertension) plus SGLT2 inhibitor therapy for all individuals, with or without a 1-year delay to treatment initiation.
C
Comparator
Usual care with current CVD treatment levels.
O
Outcome
Incremental cost-per-QALY gained (ICER) over a lifetime horizon.

Main Result

Effect estimate: ICER $80,008 per QALY gained

Guideline-optimized cardiovascular treatment combined with SGLT2 inhibitors is projected to improve long-term clinical outcomes in CKD patients at a cost-effective threshold.

Limitations

  • Reliance on evidence from a single cohort study for disease progression parameters
  • Use of aggregate risk tables instead of multivariable risk equations
  • First-event structure does not explicitly model sequences of multiple events
  • Restriction of SGLT2i treatment benefits to the 3-year period observed in clinical trials

Cite This Study

Briggs et al. (2026) studied Chronic Kidney Disease (n=100,000). Guideline-optimized cardiovascular treatment and SGLT2 inhibitor therapy vs. Usual care was evaluated on Incremental cost-effectiveness ratio (ICER) (ICER $80,008 per QALY gained). Guideline-optimized cardiovascular treatment combined with SGLT2 inhibitor therapy improved patient outcomes with an incremental cost-effectiveness ratio of $80,008 per QALY gained compared to optimized treatment alone.

synapsesocial.com/papers/6a801a2875c2e31742c86b49https://doi.org/10.1007/s41669-026-00649-8
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