• Rebecca L Tisdale, Marika M Cusick, Kelly Zhang Aluri, Thomas J Handley, Alice Kate Cummings Joyner, Joshua A Salomon, Glenn M Chertow, Jeremy D Goldhaber-Fiebert, and Douglas K Owens.
• VA Palo Alto Health Care System (152-MPD), Health Services Research and Development (HSR&D), Center for Innovation to Implementation (Ci2i), 795 Willow Road, Building 324, Menlo Park, CA, 94025, USA. rtisdale@stanford.edu.
• J Gen Intern Med. 2022 Oct 1; 37 (13): 338033873380-3387.

BackgroundIn the USA, chronic kidney disease (CKD) affects 1 in 7 adults and costs $100 billion annually. The DAPA-CKD trial found dapagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, to be effective in reducing CKD progression and mortality in patients with diabetic and non-diabetic CKD. Currently, SGLT2 inhibitors are not considered standard of care for patients with non-diabetic CKD.ObjectiveDetermine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic CKD.DesignMarkov model with lifetime time horizon and US healthcare sector perspective.PatientsPatients with non-diabetic CKD INTERVENTION: Dapagliflozin plus standard care versus standard care only.Main MeasuresQuality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually; total incidence of kidney failure on kidney replacement therapy; average years on kidney replacement therapy.Key ResultsAdding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted QALYS (from 6.75 to 8.06), and reduced the total incidence of kidney failure on kidney replacement therapy (KRT) (from 17.4 to 11.0%) and average years on KRT (from 0.77 to 0.43) over the lifetime of the cohort. Dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs (from $245,900 to $324,8900, or $60,000 per QALY gained). Results were robust to variations in assumptions about dapagliflozin's efficacy over time and by CKD stage, added costs of kidney replacement therapy, and expected population annual CKD progression rates and sensitive to the cost of dapagliflozin. The net 1-year budgetary implication of treating all US patients with non-diabetic CKD could be up to $21 billion.ConclusionsDapagliflozin improved life expectancy and reduced progression of CKD, the proportion of patients requiring kidney replacement therapy, and time on kidney replacement therapy in patients with non-diabetic CKD. Use of dapagliflozin meets conventional criteria for cost-effectiveness.© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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