Modelled CKD Benefits of Broad Sodium-Glucose Cotransporter-2 Inhibitor Eligibility in the UK

Chronic kidney disease (CKD) affects >10% of the UK population and is expected to increase. Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are effective at slowing CKD progression; however, they are underprescribed because of barriers, including the need for urine albumin-creatinine ratio (UACR) testing and lack of guideline alignment. This study sought to quantify the clinical, economic, and environmental trade-offs of broad and restrictive SGLT-2i access in the UK.

Five scenarios exploring a range of SGLT-2i eligibility criteria for patients with CKD were modelled over 10 years, beginning from 2025, using the validated IMPACT CKD individual-level microsimulation model. SGLT-2i treatment was modelled to improve estimated glomerular filtration rate (eGFR) decline and reduce cardiovascular (CV) events and acute kidney injury. A 3.5%/yr discount was applied to economic outcomes.

A maximally inclusive SGLT-2i scenario was compared with each of the less inclusive SGLT-2i eligibility criteria scenarios. Increasingly restrictive scenarios were projected to increase dialysis and all-cause mortality by 4.0% to 17.2% and 1.3% to 4.3%, respectively. Resulting from higher mortality, CKD prevalence was projected to decrease by 0.5% to 1.4%. Non-kidney replacement therapy (KRT) CKD costs and KRT costs were projected to increase by 0.7% to 2.1% and 2.4% to 10.6%, respectively, with increasingly restrictive scenarios. Total costs were projected to decrease by 15.2% to 33.9% because fewer patients are treated. Because of shifts to later stages, KRT-related environmental burden was projected to increase by 3.1% to 14.9%.

Broad SGLT-2i eligibility criteria would likely reduce the holistic burden of CKD for patients, the National Health Service (NHS), and the environment.