Kidney medicine · 2026
Cost-Effectiveness of Dapagliflozin in the Treatment of Patients With Chronic Kidney Disease in Denmark.
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Kjær Thea Tanderup, Lindhardt Morten, Riis Anders Hammerich, Birn Henrik, Ehlers Lars Holger
Аннотация
RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is a growing burden worldwide and in Denmark, with substantial clinical and economic consequences. Although national guidelines recommend sodium/glucose transporter 2 inhibitors (SGLT2i) for patients with CKD, type 2 diabetes (T2D) or heart failure (HF), underdiagnosis limits the use of SGLT2i. This study aims to inform decision makers in health care about the cost-effectiveness of current guidelines for CKD in Denmark focusing on SGLT2i dapagliflozin added to standard of care (SoC) versus SoC alone in patients with CKD.
STUDY DESIGN: Cost-effectiveness analysis based on a Markov model with a lifetime horizon.
SETTING & PARTICIPANTS: Danish health care payer perspective including a broad population with CKD and subgroups stratified by urinary albumin-creatine ratio (UACR), T2D status, and HF history.
EXPOSURES: Dapagliflozin plus SoC versus SoC alone.
OUTCOMES: Quality-adjusted life years (QALYs), life-years, total costs, and incremental cost-effectiveness ratios (ICERs).
ANALYTICAL APPROACH: A published Markov model was populated using data from the DAPA-CKD and DECLARE-TIMI 58 trials. Analyses were conducted for the overall population and stratified subgroups. Results were evaluated against an assumed willingness-to-pay (WTP) threshold of €24,158 per QALY.
RESULTS: Dapagliflozin treatment resulted in health benefits (QALYs) and life-years versus SoC irrespective of T2D/HF status or UACR levels. Dapagliflozin was cost-effective for the total population with an ICER of €7,499/QALY and dominant for subgroups with high UACR (≥200 mg/g) regardless of T2D/HF status. ICERs were below WTP threshold for all subgroups. However, for patients with CKD and low UACR (<200 mg/g) without T2D/HF, time to cost-effectiveness was long, and estimates were uncertain.
LIMITATIONS: Results are limited by generalizability, long-term uncertainty, simulated subgroup data, cost uncertainty, and lack of a Danish WTP threshold.
CONCLUSIONS: This study indicates that dapagliflozin added to SoC is cost-effective across CKD subgroups as recommended in the current Danish guideline recommendations.
STUDY DESIGN: Cost-effectiveness analysis based on a Markov model with a lifetime horizon.
SETTING & PARTICIPANTS: Danish health care payer perspective including a broad population with CKD and subgroups stratified by urinary albumin-creatine ratio (UACR), T2D status, and HF history.
EXPOSURES: Dapagliflozin plus SoC versus SoC alone.
OUTCOMES: Quality-adjusted life years (QALYs), life-years, total costs, and incremental cost-effectiveness ratios (ICERs).
ANALYTICAL APPROACH: A published Markov model was populated using data from the DAPA-CKD and DECLARE-TIMI 58 trials. Analyses were conducted for the overall population and stratified subgroups. Results were evaluated against an assumed willingness-to-pay (WTP) threshold of €24,158 per QALY.
RESULTS: Dapagliflozin treatment resulted in health benefits (QALYs) and life-years versus SoC irrespective of T2D/HF status or UACR levels. Dapagliflozin was cost-effective for the total population with an ICER of €7,499/QALY and dominant for subgroups with high UACR (≥200 mg/g) regardless of T2D/HF status. ICERs were below WTP threshold for all subgroups. However, for patients with CKD and low UACR (<200 mg/g) without T2D/HF, time to cost-effectiveness was long, and estimates were uncertain.
LIMITATIONS: Results are limited by generalizability, long-term uncertainty, simulated subgroup data, cost uncertainty, and lack of a Danish WTP threshold.
CONCLUSIONS: This study indicates that dapagliflozin added to SoC is cost-effective across CKD subgroups as recommended in the current Danish guideline recommendations.