Navarro-González Juan Francisco, Ortiz Alberto, Cebrián Cuenca Ana, Segú Lluís, Pimentel Belén, Aranda Unai, Lopez-Chicheri Blanca, Capel Margarita, Pomares Mallol Elisenda, Caudron Christian, García Sánchez Juan José, Alcázar Arroyo Roberto
Unidad de Investigación y Servicio de Nefrología, Hospital Universitario Ntra. Sra. de Candelaria, Tenerife, Spain; RICORS2040 (Kidney Disease), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Tecnologías Biomédicas, Universidad de La Laguna, Tenerife, Spain; Facultad de Ciencias de la Salud, Universidad Pernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.
Servicio de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain.
Nefrologia (Engl Ed). 2024 Nov-Dec;44(6):857-867. doi: 10.1016/j.nefroe.2024.11.020. Epub 2024 Dec 6.
Chronic kidney disease (CKD) is a serious health problem with an increasing clinical, social and economic impact in advanced stages. Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor that reduces the risk of CKD progression, in addition to provide cardiovascular benefits and reduce all-cause mortality. The aim of this study was to determine the short-term clinical and economic impact of dapagliflozin as an add-on to renin-angiotensin-aldosterone system inhibitors (RAASi) standard therapy for CKD in Spain.
A cost-offset model was used to compare the costs of clinical events and pharmacological per 100,000 CKD patients in a virtual cohort treated with dapagliflozin added to RAASi standard therapy versus RAASi standard therapy alone. Renal (progression to renal failure and acute kidney injury), cardiovascular (hospitalisation for heart failure [HF]), and all-cause mortality events were assessed. The incidence of clinical events by treatment arm was obtained from the DAPA-CKD study, and costs were obtained from national databases and the literature.
Over 3 years, treatment with dapagliflozin would reduce progression to renal failure (-33%; 7221 vs. 10,767), hospitalisation for HF (-49%; 2370 vs. 4683) and acute kidney injury (-29%; 4110 vs. 5819). The savings associated with this reduction in events was ;258 million per 100,000 patients, of which 63.4% is due to the avoidance of dialysis for renal failure. Considering the event and pharmacological treatment costs, the total net savings were estimated at ;158 million per 100,000 patients.
Delaying progression of CKD and reducing the incidence of clinical events thanks to the treatment with dapagliflozin could generate savings for the Spanish National Health System, even when pharmacological costs are taken into account.
慢性肾脏病（CKD）是一个严重的健康问题，在晚期阶段对临床、社会和经济的影响日益增加。达格列净是一种钠-葡萄糖协同转运蛋白2抑制剂，除了具有心血管益处和降低全因死亡率外，还能降低CKD进展风险。本研究的目的是确定在西班牙，达格列净作为肾素-血管紧张素-醛固酮系统抑制剂（RAASi）标准治疗CKD的附加治疗的短期临床和经济影响。
采用成本抵消模型，比较在虚拟队列中，100,000例接受达格列净联合RAASi标准治疗的CKD患者与仅接受RAASi标准治疗的患者的临床事件和药物治疗成本。评估肾脏（进展至肾衰竭和急性肾损伤）、心血管（因心力衰竭[HF]住院）和全因死亡事件。各治疗组临床事件的发生率来自DAPA-CKD研究，成本来自国家数据库和文献。
在3年期间，使用达格列净治疗可降低进展至肾衰竭的发生率（-33%；7221例对10,767例）、因HF住院的发生率（-49%；2370例对4683例）和急性肾损伤的发生率（-29%；4110例对5819例）。每100,000例患者因这些事件减少而节省的费用为2.58亿英镑，其中63.4%是由于避免了肾衰竭的透析治疗。考虑到事件和药物治疗成本，每100,000例患者的总净节省估计为1.58亿英镑。
即使考虑到药物成本，达格列净治疗延缓CKD进展并降低临床事件发生率可为西班牙国家卫生系统节省费用。
