在荷兰，用于 2 型糖尿病相关慢性肾病的非奈利酮的成本效益分析。

Cost-effectiveness of finerenone in chronic kidney disease associated with type 2 diabetes in The Netherlands.

机构信息

Department of Health Sciences, University of Groningen, Groningen, The Netherlands.

Asc Academics, Groningen, The Netherlands.

出版信息

Cardiovasc Diabetol. 2023 Nov 28;22(1):328. doi: 10.1186/s12933-023-02053-6.

BACKGROUND

In the Netherlands, more than one million patients have type 2 diabetes (T2D), and approximately 36% of these patients have chronic kidney disease (CKD). Yearly medical costs related to T2D and CKD account for approximately €1.3 billion and €805 million, respectively. The FIDELIO-DKD trial showed that the addition of finerenone to the standard of care (SoC) lowers the risk of CKD progression and cardiovascular (CV) events in patients with CKD stages 2-4 associated with T2D. This study investigates the cost-effectiveness of adding finerenone to the SoC of patients with advanced CKD and T2D compared to SoC monotherapy.

METHODS

The validated FINE-CKD model is a Markov cohort model which simulates the disease pathway of patients over a lifetime time horizon. The model was adapted to reflect the Dutch societal perspective. The model estimated the incremental costs, utilities, and incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analyses were performed to assess the effect of parameter uncertainty on model robustness.

RESULTS

When used in conjunction with SoC, finerenone extended time free of CV events and renal replacement therapy by respectively 0.30 and 0.31 life years compared to SoC alone, resulting in an extension of 0.20 quality-adjusted life years (QALYs). The reduction in renal and CV events led to a €6136 decrease in total lifetime costs per patient compared to SoC alone, establishing finerenone as a dominant treatment option. Finerenone in addition to SoC had a 83% probability of being dominant and a 93% probability of being cost-effective at a willingness-to-pay threshold of €20,000.

CONCLUSION

By reducing the risk of CKD progression and CV events, finerenone saves costs to society while gaining QALYs in patients with T2D and advanced CKD in the Netherlands.

背景

在荷兰，有超过 100 万名 2 型糖尿病（T2D）患者，其中约 36%患有慢性肾脏病（CKD）。与 T2D 和 CKD 相关的每年医疗费用分别约为 13 亿欧元和 8.05 亿欧元。FIDELIO-DKD 试验表明，在患有 2-4 期 CKD 合并 T2D 的患者中，与标准治疗（SoC）相比，添加非奈利酮可降低 CKD 进展和心血管（CV）事件的风险。本研究旨在调查与 SoC 单药治疗相比，在晚期 CKD 和 T2D 患者的 SoC 中添加非奈利酮的成本效益。

方法

经过验证的 FINE-CKD 模型是一种马尔可夫队列模型，可在患者的整个生命周期内模拟疾病进程。该模型经过改编，以反映荷兰的社会视角。该模型估计了增量成本、效用和增量成本效益比（ICER）。进行了敏感性和情景分析，以评估参数不确定性对模型稳健性的影响。

结果

与 SoC 联合使用时，与单独使用 SoC 相比，非奈利酮分别使 CV 事件和肾脏替代治疗无事件时间延长了 0.30 和 0.31 个生命年，导致 0.20 个质量调整生命年（QALY）的延长。肾脏和 CV 事件的减少使每位患者的终生总成本与单独使用 SoC 相比降低了 6136 欧元，确立了非奈利酮作为一种主导治疗方案。与单独使用 SoC 相比，非奈利酮附加 SoC 具有 83%的可能性成为主导治疗方案，具有 93%的可能性在 20000 欧元的意愿支付阈值内具有成本效益。