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Cost-Effectiveness Analysis of SGLT2 Inhibitors for Cardio-Renal-Metabolic Disease Based on Data from Japanese
Ataru Igarashi1,2,3, Hisateru Tachimori4, Keiko Maruyama-Sakurai4
1Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. atarui1@mac.com.
Insights
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are cost-effective for managing cardio-renal-metabolic diseases. This study shows SGLT2i offers significant clinical and economic benefits in type 2 diabetes and non-diabetic chronic kidney disease populations.
Area of Science:
- Pharmacoeconomics
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Cardio-renal-metabolic (CRM) diseases pose significant clinical and economic burdens due to disease interactions.
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are established treatments for CRM diseases, but their economic benefits require clarification.
Purpose of the Study:
- To evaluate the cost-effectiveness of SGLT2 inhibitors in managing cardio-renal-metabolic diseases.
- To assess the economic impact of SGLT2 inhibitors in type 2 diabetes mellitus (T2DM) and non-diabetic chronic kidney disease (non-DM CKD) populations.
Main Methods:
- Markov models were developed to simulate disease progression in T2DM and non-DM CKD populations.
- Model inputs were derived from a systematic literature search, estimating 10-year costs, QALYs, and ICERs for SGLT2i versus conventional treatment.
- Probabilistic sensitivity analysis and scenario analyses were conducted to assess the robustness of findings.
Main Results:
- SGLT2i treatment increased Quality-Adjusted Life Years (QALY) by 0.177 in T2DM and 0.457 in non-DM CKD populations.
- Total medical costs increased by JPY 99,060 (T2DM) and JPY 229,810 (non-DM CKD) with SGLT2i treatment.
- The incremental cost-effectiveness ratio (ICER) was below the JPY 5,000,000/QALY threshold in both populations (100% probability in T2DM, 98.7% in non-DM CKD).
Conclusions:
- SGLT2 inhibitor treatment is cost-effective for both T2DM and non-DM CKD populations.
- SGLT2i demonstrates potential for substantial clinical and economic advantages in comprehensive CRM disease management.
Introduction:
Cardiovascular, renal, and metabolic diseases, collectively known as cardio-renal-metabolic (CRM) disease, interact and exacerbate each other, creating serious clinical and economic burdens. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are important therapeutic agents in managing CRM disease. Despite proven clinical benefits, the economic benefits of SGLT2i in the management of CRM diseases remain unclear.
Methods:
We developed Markov models representing the natural progression of disease for two populations: a type 2 diabetes mellitus (T2DM) population and non-diabetic chronic kidney disease (non-DM CKD) population. These models incorporated key complications, including heart failure, myocardial infarction, stroke, CKD (for the T2DM population), and end-stage renal disease. A systematic literature search was conducted to determine input parameters. For each model, we estimated the 10-year medical costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER) for SGLT2i treatment compared with conventional treatment. A probabilistic sensitivity analysis (PSA) and scenario analyses with conservative assumptions were performed.
Results:
In the base-case analysis, SGLT2i treatment was estimated to increase QALY by 0.177 (7.090 vs 6.913 QALY; T2DM population) and 0.457 (6.980 vs 6.523 QALY; non-DM CKD population), and increase total medical costs by Japanese yen (JPY) 99,060 (JPY 762,524 vs 663,463; T2DM population) and JPY 229,810 (JPY 3,378,873 vs 3,149,063; non-DM CKD population), compared with conventional treatment. The ICER was JPY 559,175/QALY in the T2DM population and JPY 503,123/QALY in the non-DM CKD population. The PSA revealed that the probability of ICER being below the threshold value of JPY 5,000,000/QALY was 100% in the T2DM population and 98.7% in the non-DM CKD population, and the ICERs were below this threshold in all scenario analyses.
Conclusion:
SGLT2i treatment was demonstrated to be cost-effective in both the T2DM population and the non-DM CKD population, suggesting the potential of SGLT2i to offer significant clinical and economic benefits in the comprehensive management of CRM diseases.
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