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Kidney Week

Abstract: PO0589

The Impact of Decline in Renal Function on the Clinical and Economic Burden of CKD: An Application of the DAPA-CKD Cost-Effectiveness Model

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • McEwan, Philip, Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
  • Garcia Sanchez, Juan Jose, AstraZeneca, Cambridge, United Kingdom
  • Bergenheim, Klas, AstraZeneca, Gothenburg, Sweden
  • Darlington, Oliver T., Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
  • Wheeler, David C., University College London, London, United Kingdom
  • L Heerspink, Hiddo Jan, University of Groningen, Groningen, Netherlands
Background

The efficacy of dapagliflozin for the treatment of chronic kidney disease (CKD) was assessed in DAPA-CKD, which was stopped early for overwhelming efficacy. Cost-effectiveness analysis of new treatments plays an important role in the effective allocation of healthcare resources. The objective of this study was to develop a model for evaluating the cost-effectiveness of dapagliflozin based on the pending results of DAPA-CKD, and to demonstrate its functionality by characterizing the health economic burden of CKD progression from a UK payer perspective.

Methods

A lifetime microsimulation model was developed to estimate health economic outcomes in patients with CKD. Disease progression was modelled based on a linear decline in estimated glomerular filtration (eGFR) rate. Patients were eligible for renal replacement therapy (RRT) at end-stage renal disease. Life expectancy was estimated using a published risk equation of 10-year mortality in CKD patients. Incidence of cardiovascular (CV) events was linked to CKD stage based on published data. Outcomes were evaluated in two hypothetical patient cohorts with stage 3a CKD; one with standard eGFR decline (-0.65mL/min/1.73m2 annually) and one with rapid eGFR decline (-4.20). Published cost and utility estimates were applied and discounted at 3.5%.

Results

CKD patients with rapid eGFR decline had a reduced life expectancy of 9.1 years compared with 6.4 years in those with standard rates of eGFR decline. Patients with rapid eGFR decline experienced an additional 326 CV events per 1,000 patients and spent an additional 0.4 years receiving RRT. Reduced life expectancy, increased rates of CKD progression and CV event incidence translated to 2.4 fewer quality adjusted life years gained in patients with rapid eGFR decline (5.5 versus 7.9) and an additional £937 of direct healthcare expenditure.

Conclusion

The DAPA-CKD cost-effectiveness model is capable of estimating health economic outcomes in patients with CKD, projecting health benefits and costs consistent with previously published estimates. This study shows that improved diagnosis and management of CKD may reduce the burden imposed by CKD on both patients and healthcare systems.

Funding

  • Commercial Support