VA Palo Alto Health Care System (152-MPD), Health Services Research and Development (HSR&D), Center for Innovation to Implementation (Ci2i), 795 Willow Road, Building 324, Menlo Park, CA, 94025, USA.
Department of Health Policy, School of Medicine, and Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.
J Gen Intern Med. 2022 Oct;37(13):3380-3387. doi: 10.1007/s11606-021-07311-5. Epub 2022 Feb 8.
In the USA, chronic kidney disease (CKD) affects 1 in 7 adults and costs $100 billion annually. The DAPA-CKD trial found dapagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, to be effective in reducing CKD progression and mortality in patients with diabetic and non-diabetic CKD. Currently, SGLT2 inhibitors are not considered standard of care for patients with non-diabetic CKD.
Determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic CKD.
Markov model with lifetime time horizon and US healthcare sector perspective.
Patients with non-diabetic CKD INTERVENTION: Dapagliflozin plus standard care versus standard care only.
Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually; total incidence of kidney failure on kidney replacement therapy; average years on kidney replacement therapy.
Adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted QALYS (from 6.75 to 8.06), and reduced the total incidence of kidney failure on kidney replacement therapy (KRT) (from 17.4 to 11.0%) and average years on KRT (from 0.77 to 0.43) over the lifetime of the cohort. Dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs (from $245,900 to $324,8900, or $60,000 per QALY gained). Results were robust to variations in assumptions about dapagliflozin's efficacy over time and by CKD stage, added costs of kidney replacement therapy, and expected population annual CKD progression rates and sensitive to the cost of dapagliflozin. The net 1-year budgetary implication of treating all US patients with non-diabetic CKD could be up to $21 billion.
Dapagliflozin improved life expectancy and reduced progression of CKD, the proportion of patients requiring kidney replacement therapy, and time on kidney replacement therapy in patients with non-diabetic CKD. Use of dapagliflozin meets conventional criteria for cost-effectiveness.
在美国，慢性肾脏病（CKD）影响每 7 个成年人中的 1 人，每年花费 1000 亿美元。DAPA-CKD 试验发现，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂达格列净可有效减少糖尿病和非糖尿病 CKD 患者的 CKD 进展和死亡率。目前，SGLT2 抑制剂不被认为是治疗非糖尿病 CKD 患者的标准治疗方法。
确定在非糖尿病 CKD 患者的标准治疗中添加达格列净的成本效益。
具有终生时间范围和美国医疗保健部门视角的 Markov 模型。
非糖尿病 CKD 患者
达格列净加标准治疗与仅标准治疗。
质量调整生命年（QALYs）、成本和增量成本效益比（ICERs），均按每年 3%贴现；接受肾脏替代治疗的肾衰竭总发生率；接受肾脏替代治疗的平均年限。
在标准治疗中添加达格列净可使预期寿命延长 2 年，增加贴现 QALY（从 6.75 增加到 8.06），降低接受肾脏替代治疗的肾衰竭总发生率（从 17.4%减少到 11.0%）和接受肾脏替代治疗的平均年限（从 0.77 年减少到 0.43 年）。达格列净加标准治疗比单独使用标准治疗更有效，同时增加了终生成本（从 245900 美元增加到 3248900 美元，或每获得一个 QALY 增加 60000 美元）。结果对达格列净疗效随时间和 CKD 阶段的变化、肾脏替代治疗的附加成本以及预期的年度 CKD 进展率的假设以及对达格列净成本的敏感性具有稳健性。治疗所有美国非糖尿病 CKD 患者的 1 年净预算影响可能高达 210 亿美元。
达格列净改善了非糖尿病 CKD 患者的预期寿命，减少了 CKD 的进展、需要肾脏替代治疗的患者比例以及接受肾脏替代治疗的患者的治疗时间。达格列净的使用符合成本效益的常规标准。
