Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo.
Circ J. 2022 Nov 25;86(12):2021-2028. doi: 10.1253/circj.CJ-22-0086. Epub 2022 Sep 6.
The cost-effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors for chronic kidney disease (CKD) has not been evaluated in Japan, so we analyzed the cost-effectiveness of dapagliflozin, an SGLT2 inhibitor, for CKD stages 3a and 3b.
We used the Markov model for CKD to assess the costs and benefits associated with and without dapagliflozin from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as per quality-adjusted life-years (QALYs). An ICER <5 million Japanese yen (JPY)/QALY was judged to be cost-effective. The effect of dapagliflozin on renal and cardiovascular events was based on published clinical trials. In patients with CKD stage 3a, the ICER of dapagliflozin over standard treatment was 4.03 million JPY/QALY gained. With a cost-effectiveness threshold of 5 million JPY/QALY gained, the cost-effectiveness probability of dapagliflozin over standard treatment was 52.6%. In patients with CKD stage 3b, the ICER of dapagliflozin over standard treatment was 0.12 million JPY/QALY gained. The cost-effectiveness probability of dapagliflozin over standard treatment was 75.2%.
The results seemed to show acceptable cost-effectiveness when dapagliflozin was used for CKD stage 3b. On the other hand, cost-effectiveness of dapagliflozin for CKD stage 3a was ambiguous, and further validation is needed.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂在日本尚未评估其用于慢性肾脏病（CKD）的成本效益，因此我们分析了 SGLT2 抑制剂达格列净在 CKD 3a 和 3b 期的成本效益。
我们使用 CKD 的 Markov 模型，从卫生系统的角度评估了达格列净与无达格列净治疗相关的成本和效益。我们估计了增量成本效益比（ICER），表示为每质量调整生命年（QALY）。ICER<500 万日元（JPY）/QALY 被认为是具有成本效益的。达格列净对肾脏和心血管事件的影响基于已发表的临床试验。在 CKD 3a 期患者中，达格列净治疗标准治疗的 ICER 为 403 万日元/QALY 获益。在成本效益阈值为 500 万日元/QALY 获益的情况下，达格列净治疗标准治疗的成本效益概率为 52.6%。在 CKD 3b 期患者中，达格列净治疗标准治疗的 ICER 为 12 万日元/QALY 获益。达格列净治疗标准治疗的成本效益概率为 75.2%。
当达格列净用于 CKD 3b 期时，结果似乎显示出可接受的成本效益。另一方面，达格列净治疗 CKD 3a 期的成本效益不明确，需要进一步验证。
