Quist Sara Wilhelmien, van Loon Jeanni, Bakker Stephan, Pochopién Michal, Postma Maarten J, Paulissen Jeroen
Health Sciences, Groningen University Department of Health Sciences, Groningen, Groningen, Netherlands.
Asc Academics BV, Groningen, Groningen, Netherlands.
BMJ Public Health. 2025 Jun 25;3(1):e001288. doi: 10.1136/bmjph-2024-001288. eCollection 2025.
One in three patients with type 2 diabetes (T2D) suffers from any stage of chronic kidney disease (CKD), a chronic illness associated with a high global burden that impacts not only the healthcare system but also societal costs. Addition of finerenone to the standard of care (SoC) for patients with advanced CKD and T2D has been shown to be cost-effective by reducing healthcare and societal costs. This analysis explores the cost-effectiveness of finerenone in patients with CKD (stages 1-4 with albuminuria) associated with T2D from a societal perspective, as broader societal costs are a crucial consideration in managing chronic illnesses.
The validated FINE-CKD model was populated with data from the pooled FIDELITY analysis (ie, a patient population with early-to-late stage CKD associated with T2D) to investigate the cost-effectiveness of the addition of finerenone to SoC compared with SoC alone, from a Dutch societal perspective. Sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the robustness of the model.
Our analysis shows that by adding finerenone to SoC, patients with mild to severe stage CKD and T2D gain 0.14 quality-adjusted life years (QALYs) compared with SoC alone, mainly due to a reduction in renal and cardiovascular events. The societal costs of these events are considerable (ie, €8481 and €9799 per patient over a lifetime in the finerenone and SoC arm, respectively), showing the relevance of a societal perspective in chronic diseases. Overall, finerenone leads to savings of €2713 per patient over a lifetime. Therefore, the addition of finerenone to SoC emerges as the dominant treatment option when compared with SoC alone. The sensitivity analysis shows that finerenone has a 62.3% chance to be dominant and an 83.8% chance to be cost-effective, considering a willingness-to-pay threshold of €20 000/QALY.
This study highlights the burden that chronic diseases impose on healthcare systems and society, emphasising the relevance of incorporating a societal perspective in cost-effectiveness analyses. The analysis estimates that adding finerenone to SoC treatment for patients with mild to advanced CKD associated with is cost-effective from a healthcare and societal perspective.
三分之一的2型糖尿病（T2D）患者患有慢性肾脏病（CKD）的任何阶段，这是一种全球负担沉重的慢性疾病，不仅影响医疗保健系统，还影响社会成本。对于晚期CKD和T2D患者，在标准治疗（SoC）基础上加用非奈利酮已被证明通过降低医疗保健和社会成本具有成本效益。本分析从社会角度探讨非奈利酮在与T2D相关的CKD（1-4期伴蛋白尿）患者中的成本效益，因为更广泛的社会成本是管理慢性病的关键考虑因素。
使用来自汇总的FIDELITY分析（即患有早期至晚期与T2D相关的CKD的患者群体）的数据填充经过验证的FINE-CKD模型，从荷兰社会角度研究在SoC基础上加用非奈利酮与单独使用SoC相比的成本效益。进行敏感性分析以评估参数不确定性对模型稳健性的影响。
我们的分析表明，在SoC基础上加用非奈利酮，轻度至重度CKD和T2D患者与单独使用SoC相比可获得0.14个质量调整生命年（QALY），主要是由于肾脏和心血管事件减少。这些事件的社会成本相当可观（即非奈利酮组和SoC组患者一生中每位患者分别为8481欧元和9799欧元），表明社会角度在慢性病中的相关性。总体而言，非奈利酮使每位患者一生中节省2713欧元。因此，与单独使用SoC相比，在SoC基础上加用非奈利酮成为主要治疗选择。敏感性分析表明，考虑到支付意愿阈值为20000欧元/QALY，非奈利酮有62.3%的机会成为主要治疗选择，有83.8%的机会具有成本效益。
本研究强调了慢性病对医疗保健系统和社会造成的负担，强调在成本效益分析中纳入社会角度的相关性。该分析估计，从医疗保健和社会角度来看，在SoC治疗中为轻度至重度CKD患者加用非奈利酮具有成本效益。
