Cost-effectiveness of combining finerenone and sodium-glucose cotransporter 2 inhibitors with standard of care for patients with chronic kidney disease and type 2 diabetes in China

OBJECTIVE: To evaluate the cost-effectiveness of combining finerenone and Sodium-glucose cotransporter-2 inhibitors (SGLT2i) with standard care (SoC) for Chinese patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). METHODS: ) was employed to simulate health outcomes and costs from a Chinese healthcare system perspective. Transition probabilities, costs, and utilities were derived from peer-reviewed literature and trial data. The model utilized a 4-month cycle length, consistent with the assessment intervals in the FIDELITY trial, over a ten-year time horizon. The primary economic outcome was the net monetary benefit (NMB). Cost-effectiveness was assessed against China's willingness-to-pay (WTP) threshold, defined as three times the 2023 GDP per capita (268,074 CNY/QALY), following China's pharmacoeconomic evaluation guidelines. RESULTS: Triple therapy (finerenone + SGLT2i + SoC) demonstrated superior clinical and economic outcomes compared to finerenone therapy (finerenone + SoC) and SGLT2i therapy (SGLT2i + SoC). Specifically, compared to finerenone therapy, triple therapy resulted in cost savings of CNY 102,953.11 and an incremental gain of 0.291 quality-adjusted life years (QALYs), yielding an NMB of CNY 181,032.95. Compared to SGLT2i therapy, triple therapy led to cost savings of CNY 118,628.19 and an additional 0.257 QALYs, corresponding to an NMB of CNY 187,506.53. Sensitivity analyses confirmed the robustness of these findings. CONCLUSIONS: Triple therapy with finerenone, SGLT2i, and SoC is cost-effective for Chinese patients with T2D and CKD, delivering synergistic cardiovascular and renal protective effects while demonstrating robust economic viability within China's healthcare framework.