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Cost-Effectiveness of Empagliflozin (JARDIANCE®) in the Treatment of Patients with Chronic Kidney Disease in France, Based on the EMPA-KIDNEY Clinical Trial

Authors: Groyer, Harinala; Supiot, Romain; Tardu, Jean; Virely, Nicolas; Sivignon, Marine; San, Denis; Lévy, Pierre; +2 Authors

Cost-Effectiveness of Empagliflozin (JARDIANCE®) in the Treatment of Patients with Chronic Kidney Disease in France, Based on the EMPA-KIDNEY Clinical Trial

Abstract

The efficacy and safety of empagliflozin in the treatment of chronic kidney disease (CKD) were demonstrated in the EMPA-KIDNEY trial, which showed a 28% reduction in combined risks of kidney disease or death from cardiovascular causes (hazard ratio, 0.72; 95% confidence interval, 0.64-0.82; p < 0.001) compared with placebo. Based on these results, the present study aimed to assess the cost-effectiveness of empagliflozin + standard of care (SoC) compared with SoC alone in the treatment of CKD in France.A Markov state microsimulation model was adapted to compare the health and economic outcomes in France, considering a healthcare system perspective, in patients treated with empagliflozin in addition to SoC versus patients treated with SoC alone. The model simulated the intention-to-treat population of the trial, transitioning between 18 mutually exclusive and collectively exhaustive health states defined based on the Kidney Disease: Improving Global Outcomes classification. For each arm, the model estimated (over a 25-year time horizon) the number of events and deaths, and the costs associated with these events, to calculate the incremental cost-effectiveness ratio. The resources used were derived using French authorities reports, literature, and French CKD guidelines. Both economic and health outcomes were discounted at a 2.5% annual rate according to French guidelines.The model predicted that using empagliflozin + SoC to treat patients with CKD would prevent CKD-related complications and deaths associated with a cardiovascular event or all-cause deaths while in kidney replacement therapy, resulting on average in a discounted gain of 1.29 years in overall survival (9.48 years vs. 8.19 with SoC alone). Empagliflozin costs (treatment, events, and disease management) were completely offset by the cost savings from avoided kidney failure events. Overall, empagliflozin + SoC would be more effective and less costly than SoC alone and would therefore be the dominant treatment strategy. The sensitivity analyses conducted support the results' robustness in showing the dominance of empagliflozin + SoC over SoC alone.The base-case results indicate that empagliflozin + SoC is a dominant strategy compared with the current SoC for the management of CKD in France. Empagliflozin + SoC would have a positive impact on patients with CKD by slowing CKD progression and leading to the prevention of kidney failure events on top of all-stages CKD complications.

Keywords

Benzhydryl Compounds/therapeutic use [MeSH] ; Female [MeSH] ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use [MeSH] ; Cost-Benefit Analysis [MeSH] ; Aged [MeSH] ; Humans [MeSH] ; Middle Aged [MeSH] ; France [MeSH] ; Benzhydryl Compounds/economics [MeSH] ; Renal Insufficiency, Chronic/economics [MeSH] ; Glucosides/therapeutic use [MeSH] ; Male [MeSH] ; Markov Chains [MeSH] ; Sodium-Glucose Transporter 2 Inhibitors/economics [MeSH] ; Glucosides/economics [MeSH] ; Original Research Article ; Renal Insufficiency, Chronic/drug therapy [MeSH], Male, [SDV]Life Sciences [q-bio], Cost-Benefit Analysis, Economie sociale, 610, I.I1.I12, treatment of chronic kidney disease (CKD), Trial, I.I1.I11, 334, Education, Glucosides, Humans, Original Research Article, and Welfare::I1 - Health::I12 - Health Behavior, Benzhydryl Compounds, Renal Insufficiency, Chronic, Sodium-Glucose Transporter 2 Inhibitors, Aged, and Welfare::I1 - Health::I11 - Analysis of Health Care Markets, Middle Aged, healthcare system, Markov Chains, [SDV] Life Sciences [q-bio], economic outcomes, Female, France, I - Health

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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