Adding empagliflozin to standard of care may be cost-effective for diabetic kidney disease
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For commercial insurers and Medicare, it may be cost-effective to add empagliflozin to the standard of care treatment for patients with diabetic kidney disease, according to data published in the American Journal of Kidney Diseases.
“Kidney injury is a common complication of type 2 diabetes that is associated with increased risk of cardiovascular events and death in this population. Empagliflozin demonstrated slower kidney disease progression and lower kidney event rates than placebo when combined with standard of care (SOC) in the EMPA-REG OUTCOME trial,” Odette S. Reifsnider, PhD, a research scientist from Evidera in Maryland, and colleagues wrote. They added, “This study assessed the cost-effectiveness of empagliflozin with SOC [vs.] SOC alone in patients with [diabetic kidney disease] DKD over a lifetime horizon from the perspective of U.S. commercial insurers and Medicare.”
In a cost-effective analysis, researchers compared the costs and benefits of empagliflozin vs. SOC without it. Measurements were based on the incremental cost-effectiveness ratio, which calculated the increase in costs after adding empagliflozin to DKD treatment and dividing it by the gains in quality-adjusted life-years (QALYs). Using a discrete-event simulation, researchers estimated total lifetime costs and QALYs of DKD treatment with vs. without an SGLT inhibitor on hypothetical patients.
Analyses revealed the incremental cost-effectiveness ratio of empagliflozin with SOC vs. SOC alone was $25,975 per QALY. Additionally, empagliflozin added 0.67 QALYs and $17,322 per patient during a lifetime horizon. Overall, 91% of simulations yielded incremental cost-effectiveness ratios of less than $50,000 per QALY.
In an editorial, Eugene Lin, MD, MS, from the University of Southern California, and colleagues wrote, “Although this study suggests that SGLT2 inhibitors are relatively inexpensive, the findings come with important caveats. First, the certainty of the cost-effectiveness estimates wanes over longer time horizons, and the true economic impact of empagliflozin might not correlate with long-term use. Second, the drug’s cost varies substantially depending on the payer, wholesale price and market competition with other SGLT2 inhibitors.”
According to the study, commercial insurers and Medicare might consider prescribing empagliflozin with SOC to patients with DKD to “improve clinical outcomes and patient quality of life at an acceptable willingness-to-pay threshold for the health care system.”
Reference:
- Time to Invest in the Future: Assessing the cost-effectiveness of empagliflozin in diabetic kidney disease. https://www.ajkd.org/article/S0272-6386(21)01012-X/fulltext. Published Feb. 1, 2022. Accessed Feb. 10, 2022.
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