Kidney Week

Abstract: FR-PO0087

Cost-Benefit Analysis of Tolvaptan for ADPKD in Kuwait: A KDIGO-Guided Markov Model

Session Information

• ADPKD and Cystic Kidney Disease - 2
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1201 Genetic Diseases of the Kidneys: Cystic (Monogenic)

Authors

• Al Rajab, Heba, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Heba Al Rajab, MD

• Bahbahani, Yousif, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Yousif Bahbahani, MBChB

• Almomen, Mohammad, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Mohammad Almomen, MD

• Bahbahani, Hamad Mahdi, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Hamad Mahdi Bahbahani, MD, MBChB

• Ayoub, Medhat N., ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Medhat N. Ayoub, MD, PhD

• Almutawa, Sarah F A M A, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Sarah F A M A Almutawa, MD

• Almutar, Sara, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Sara Almutar, MD

• Alsharhan, Loulwa, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Loulwa Alsharhan, MBChB

• Alherz, Hawraa, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Hawraa Alherz, PharmD

• Assiri, Danah, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Danah Assiri, MSc

• Mihdawi, Duaa Zeyad, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Duaa Zeyad Mihdawi, RN

• Abdalla, Sherok Akram, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Sherok Akram Abdalla

• Abu-Farha, Mohamed, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Mohamed Abu-Farha, PhD

• Ali, Hamad, ADPKD National Clinic, Mubarak Al Kabeer Hospital, Ministry of Health, Jabriya, Al Asimah Governorate, Kuwait

Hamad Ali, MS, PhD

Group or Team Name

• ADPKD National Clinic of Kuwait

Background

Tolvaptan slows kidney-function decline in ADPKD but its high cost limits implementation. In Kuwait, healthcare for citizens is government-funded, & tolvaptan is currently procured through an extended international supply chain because of limited direct manufacturer engagement with the local market. This results in a high procurement cost of approximately USD 4,875 per patient per month. We evaluated the clinical, economic, & societal value of KDIGO-guided tolvaptan use in Kuwaiti patients with ADPKD.

Methods

We developed a Markov model comparing KDIGO 2025-guided tolvaptan plus standard care versus standard care alone in adults with ADPKD. Eligibility was limited to patients with eGFR ≥25 mL/min/1.73 m2 & rapid or likely rapid progression based on Mayo class, eGFR decline, or high-risk clinical/genetic features. The model incorporated split-dose titration, liver-function monitoring, discontinuation, contraindications, delayed kidney replacement therapy, drug and monitoring costs, dialysis delay, productivity preservation, & societal burden.

Results

At Kuwait’s current procurement price, annual tolvaptan cost was USD 58,500 per patient, before monitoring. KDIGO-guided eligibility reduced the treated population by an estimated 40–60% versus unrestricted use. In the base case, early initiation in eligible high-risk patients delayed kidney replacement therapy by 3–5 years, compared with 2–3 years for mid-stage initiation and <1–2 years for late initiation. Over 20 years, delayed dialysis offset approximately USD 150,000–300,000 per patient, depending on the duration of benefit. Although drug expenditure exceeded direct short-term savings at current pricing, early treatment became more favorable when QALY/DALY gains, productivity preservation, and reduced family burden were included. Model outputs were most sensitive to drug price, dialysis delay, discontinuation, and KDIGO-based eligibility assumptions.

Conclusion

At current procurement prices, tolvaptan is unlikely to be cost-saving if used broadly for all ADPKD patients in Kuwait. However, KDIGO-guided administration in carefully selected high-risk patients may provide meaningful clinical and societal value, particularly when started early. Local or regional price negotiation, direct procurement pathways, and structured eligibility criteria are essential to improve affordability and support sustainable implementation in a government-funded health system.

Acknowledgment

We gratefully acknowledge the Kuwait Foundation for the Advancement of Sciences (KFAS) for supporting the ADPKD National Clinic in Kuwait. The support has helped translate ADPKD research into improved clinical care, strengthening diagnosis, risk stratification, monitoring, and precision nephrology. We also acknowledge the KFAS–NASEM Precision Medicine Workshop for fostering knowledge exchange and advancing Kuwait’s precision medicine vision.