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Cost Utility Analysis of Dapagliflozin in Egyptian Patients with CKD from the Payer Perspective

Open Journal of Nephrology 2023年第4期13卷 435-450页

作者： Gamal Saadi Magdy Elsharkawy Gamal Fathy El-Naggar Ahmed F. Elkeraie Emad R. Issak Department of Nephrology Faculty of Medicine Kasr Al-Aini Cairo University Cairo Egypt Department of Nephrology Faculty of Medicine Ain-Shams University Cairo Egypt Department of Nephrology Faculty of Medicine Tanta University Tanta Egypt Department of Nephrology Faculty of Medicine Alexandria University Alexandria Egypt Department of Internal Medicine Faculty of Medicine Ain-Shams University Cairo Egypt

Background: Chronic kidney disease is a serious public health issue in Egypt. An estimated 13% of individuals in Egypt are expected to have CKD, with a higher prevalence among older adults and in rural regions. The primary goal of the study was to compare the cost-utility of the standard of care alone against add-on medication, dapagliflozin, as a preventative measure against complications of CKD in cases with or without diabetes mellitus. Methods: A lifetime Markov state transition model with a 3-month cycle was employed based on the clinical evidence from the DAPA-CKD clinical trial. The model was to provide estimates of the long-term economic and health impact of managing CKD patients. Cost-effectiveness is assessed regarding the cost per quality-adjusted life year (QALY) gained. This economic evaluation study used a payer perspective. Moreover, the study evaluated the impact on the budget due to the undertaking of dapagliflozin. One-way deterministic sensitivity analyses, as well as a probabilistic sensitivity analysis, were employed. Results: During a lifetime horizon, the difference in cost between dapagliflozin and SOC was EGP -65,212 (USD 2126.89). The difference in QALY between dapagliflozin and SOC was 4.3. In CKD patients, adding dapagliflozin to ramipril generates better QALYs and lower costs than ramipril alone. Dapagliflozin improved the outcomes and generated cost savings. A deterministic one was sensitivity analysis revealed that the model is robust to changes in all variables included. Probabilistic sensitivity analysis using Monte Carlo simulation with 10,000 iterations showed that in about 82.64% of trials, dapagliflozin is cost-saving. The undertaking of dapagliflozin by any percent will have a positive impact on the budget. Conclusion: During the lifetime horizon, dapagliflozin is cost-saving;it benefits the quality of life and the total cost. The addition of dapagliflozin to SOC has a saving effect of 11.9% of the budget.

关键词： Chronic Kidney Disease Sodium-Glucose Cotransporter-2 Inhibitors Dapagliflozin Cost-Utility budget impact

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