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Kidney Week

Abstract: SA-OR080

Cost Effectiveness Analysis of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors Treatment in Patients with Diabetic Kidney Disease for Cardiovascular and Renal Protection in Singapore

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Liew, Adrian, Tan Tock Seng Hospital, Singapore, Singapore
  • Weng, Wanting, Tan Tock Seng Hospital, Singapore, Singapore
  • Ang, Yee, National Healthcare Group, Singapore, Singapore, Singapore
  • George, Pradeep paul, National Healthcare Group, Singapore, Singapore, Singapore
  • Heng, Bee hoon, National Healthcare Group, Singapore, Singapore, Singapore
  • Lim, Chee Kong, National Healthcare Group Polyclinics, Singapore, Singapore
Background

Diabetic Kidney Disease (DKD) is a major cause of end stage kidney disease (ESKD) in Singapore. Whilst major trials showed that SGLT2 inhibitors (SGLT2i) improve renal and cardiovascular outcomes in patients with DKD, drug cost is a significant deterrent. We aim to analyse the cost effectiveness of SGLT2i treatment, when added to standard therapy in patients with DKD, for the reduction of cardiovascular and renal events in Singapore.

Methods

All patients with Type 2 diabetes and CKD stages 1 to 3B on follow up with 9 primary care facilities between January 2008 to January 2011 were included in the study population. Incidence of acute myocardial infarct (AMI), ESRD and all-cause mortality were determined and the annual cost of AMI and ESRD requring dialysis and the cost of SGLT2i were calculated using data from the Regional Healthcare System (RHS) Database. Results of the risk reduction for the above outcomes were obtained from CREDENCE, CANVAS, DECLARE and EMPA-REG trials to determine the incremental cost effectiveness ratio (ICER) if SGLT2i were initiated on this historical cohort.

Results

6281 patients with Type 2 DM and CKD stages 1 to 3B were included in the study. The rates of AMI, all-cause mortality and ESRD was 7.9/1000, 75.2/1000 and 18.1/1000 patient-year respectively. If SGLT2i were initiated, the cost to prevent 1 mortality and 1 ESRD ranged from USD $11 857-40 174 and USD $19 888-63 356 respectively but the cost to prevent 1 AMI was substantially higher. ICER of less than USD $57 827 (equivalent to GDP per capita) was determined to be cost effective in the study. Addition of SGLT2i to standard therapy to reduce cardiovascular and renal events seems cost effective for preventing deaths and progression to ESRD. (Table 1)

Conclusion

Addition of SGLT2i to standard therapy in our diabetic CKD patients can potentially improve outcomes and may be cost effective for preventing deaths and progression to ESRD.