Alnsasra Hilmi, Tsaban Gal, Solomon Adam, Khalil Fouad, Aboalhasan Enis, Azab Abed N, Azuri Joseph, Hammerman Ariel, Arbel Ronen
Department of Cardiology, Soroka University Medical Center, Beersheba, Israel.
Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Front Pharmacol. 2023 Aug 4;14:1227199. doi: 10.3389/fphar.2023.1227199. eCollection 2023.
Dapagliflozin and empagliflozin have demonstrated favorable clinical outcomes among patients with chronic kidney disease (CKD). However, their comparative monetary value for improving outcomes in CKD patients is unestablished. We examined the cost-per-outcome implications of utilizing dapagliflozin as compared to empagliflozin for prevention of renal and cardiovascular events in CKD patients. For calculation of preventable events we divided the allocated budget by the cost needed to treat (CNT) for preventing a single renal or cardiovascular event. CNT was derived by multiplying the annualized number needed to treat (aNNT) by the annual therapy cost. The aNNTs were determined based on data from the DAPA-CKD and EMPEROR-KIDNEY trials. The budget limit was defined based on the threshold recommended by the United States' Institute for Clinical and Economic Review. The aNNT was 42 both dapagliflozin (95% confidence interval [CI]: 34-59) and empagliflozin (CI: 33-66). The CNT estimates for the prevention of one primary event for dapagliflozin and empagliflozin were comparable at $201,911 (CI: $163,452-$283,636) and $209,664 (CI: $164,736-$329,472), respectively. However, diabetic patients had a higher CNT with dapagliflozin ($201,911 [CI: $153,837-$346,133]) than empagliflozin ($134,784 [CI: $109,824-$214,656]), whereas non-diabetic patients had lower CNT for dapagliflozin ($197,103 [CI: $149,029-$346,133]) than empagliflozin ($394,368 [CI: $219,648-$7,093,632]). The CNT for preventing CKD progression was higher for dapagliflozin ($427,858 [CI: $307,673-$855,717]) than empagliflozin ($224,640 [CI: $169,728-$344,448]). For preventing cardiovascular death (CVD), the CNT was lower for dapagliflozin ($1,634,515 [CI: $740,339-∞]) than empagliflozin ($2,990,208 [CI: $1,193,088-∞]). Among patients with CKD, empagliflozin provides a better monetary value for preventing the composite renal and cardiovascular events in diabetic patients while dapagliflozin has a better value for non-diabetic patients. Dapagliflozin provides a better monetary value for the prevention of CVD, whereas empagliflozin has a better value for the prevention of CKD progression.
达格列净和恩格列净已在慢性肾脏病（CKD）患者中展现出良好的临床疗效。然而，它们在改善CKD患者预后方面的相对货币价值尚未明确。我们研究了与恩格列净相比，使用达格列净预防CKD患者肾脏和心血管事件的每预后成本影响。为了计算可预防事件，我们将分配的预算除以预防单一肾脏或心血管事件所需的治疗成本（CNT）。CNT通过将年度治疗所需人数（aNNT）乘以年度治疗成本得出。aNNT基于达格列净治疗慢性肾脏病（DAPA - CKD）试验和恩格列净治疗慢性肾脏病（EMPEROR - KIDNEY）试验的数据确定。预算限制根据美国临床和经济审查研究所推荐的阈值定义。达格列净（95%置信区间[CI]：34 - 59）和恩格列净（CI：33 - 66）的aNNT均为42。达格列净和恩格列净预防一次主要事件的CNT估计值相当，分别为201,911美元（CI：163,452 - 283,636美元）和209,664美元（CI：164,736 - 329,472美元）。然而，糖尿病患者使用达格列净的CNT（201,911美元[CI：153,837 - 346,133美元]）高于恩格列净（134,784美元[CI：109,824 - 214,656美元]），而非糖尿病患者使用达格列净的CNT（197,103美元[CI：149,029 - 346,133美元]）低于恩格列净（394,368美元[CI：219,648 - 7,093,632美元]）。达格列净预防CKD进展的CNT（427,858美元[CI：307,673 - 855,717美元]）高于恩格列净（224,640美元[CI：169,728 - 344,448美元]）。对于预防心血管死亡（CVD），达格列净的CNT（1,634,515美元[CI：740,339 - ∞]）低于恩格列净（2,990,208美元[CI：1,193,088 - ∞]）。在CKD患者中，恩格列净在预防糖尿病患者的复合肾脏和心血管事件方面具有更好的货币价值，而达格列净在非糖尿病患者中具有更好的价值。达格列净在预防CVD方面具有更好的货币价值，而恩格列净在预防CKD进展方面具有更好的价值。
