Nephrology Department, Dar Elshifa Hospital, Kuwait City, Kuwait.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
J Med Econ. 2023 Jan-Dec;26(1):271-282. doi: 10.1080/13696998.2023.2174749.
In 2019, the prevalence of dialysis in Kuwait were 465 patient/million population, while the annual mortality rate among dialysis patients reached 12%. To improve resource allocation within the health care system, a cost-effectiveness model was conducted from a societal perspective to assess the cost-effectiveness of the use of dapagliflozin as an add-on-therapy against SoC (ramipril) among CKD patients with or without type-2 diabetes over their lifetime.
A Markov process model was utilized to assess the cost-effectiveness of dapagliflozin + ramipril versus ramipril alone on a cohort of patients with an eGFR of 25 to 75 mL/min/1.73, with or without type-2 diabetes and a urinary ACR of 200 to 5,000 over their lifetime. The model included nine health states: (i) the six stages of CKD representing stages 1, 2, 3a, 3b, 4 and 5; (ii)ESRD, which represents RRT as dialysis or kidney transplant and (iii) death. Most of the clinical data were captured from the DAPA-CKD study. We assumed that the mortality risk of our study was similar to DAPA-CKD. The utility data were captured from different studies. Direct medical and indirect costs were captured from local data sources. Sensitivity analyses were conducted.
The difference in QALY between dapagliflozin + ramipril versus ramipril was 0.2. The difference in cost between the two arms was KWD -4,120 (-USD25750). Dapagliflozin + ramipril generate better QALYs and lower costs than ramipril in CKD patients. Dapagliflozin improved the outcomes and generated cost savings in CKD patients.
Adoption of dapagliflozin + ramipril is considered to be a cost saving option in addition to the improvement in QALYs in CKD patients with or without type-2 diabetes due to its nephroprotective effect, regardless of the aetiology of CKD, which eventually leads to reduction of dialysis and the transplantation cost burden on the Kuwaiti health care system. This study was focussed only on DAPA-CKD cohort.
2019 年，科威特的透析患者人数为 465 人/百万人口，而透析患者的年死亡率达到 12%。为了改善医疗保健系统内的资源配置，本研究从社会角度出发，建立成本效益模型，评估达格列净作为附加疗法联合 soc（雷米普利）治疗伴有或不伴有 2 型糖尿病的慢性肾脏病患者的成本效益，该模型覆盖了患者的一生。
本研究使用马尔可夫过程模型，评估了达格列净+雷米普利对比雷米普利单独用于肾小球滤过率为 25 至 75ml/min/1.73ml、伴有或不伴有 2 型糖尿病和尿白蛋白肌酐比为 200 至 5000 的患者的成本效益，这些患者的一生都处于慢性肾脏病的六个阶段（1 期、2 期、3a 期、3b 期、4 期和 5 期）、终末期肾病（代表透析或肾移植的肾脏替代治疗）和死亡这 9 种健康状态。大多数临床数据均来自 DAPA-CKD 研究。我们假设研究的死亡率与 DAPA-CKD 相似。效用数据来自不同的研究。直接医疗成本和间接成本来自当地数据源。进行了敏感性分析。
达格列净+雷米普利对比雷米普利的 QALY 差异为 0.2，成本差异为-4120 科威特第纳尔（-25750 美元）。与雷米普利相比，达格列净+雷米普利在伴有或不伴有 2 型糖尿病的慢性肾脏病患者中能更好地提高 QALY 并降低成本。达格列净改善了慢性肾脏病患者的结局，并降低了医疗成本。
达格列净+雷米普利的应用被认为是一种节省成本的选择，因为它具有肾脏保护作用，可以改善伴有或不伴有 2 型糖尿病的慢性肾脏病患者的 QALY，无论慢性肾脏病的病因如何，这最终将减少透析和肾移植的成本负担，减轻科威特医疗保健系统的负担。本研究仅关注 DAPA-CKD 队列。
