Cost-utility analysis of sodium-glucose cotransporter-2 inhibitors on chronic kidney disease progression in patients with type 2 diabetes mellitus

Abstract

Background: Many trials have highlighted the benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2is) in terms of chronic kidney disease (CKD) progression. However, SGLT2is are high-cost medication, and their cost- effectiveness varies by setting across countries. Methods: This study aimed to evaluate the cost-effectiveness of sodium-glucose co-transporter 2 inhibitors (SGLT2is) in terms of chronic kidney disease (CKD) progression by utilizing data from the type 2 diabetes mellitus (T2D) cohort collected from 2010 to 2022 to estimate transitional probabilities and costs. Markov models were constructed from the following states: CKD stage 3, 4, 5, and death. Cost and quality-adjusted life year (QALY) were estimated for SGLT2i and non-SGLT2i groups from both hospital and societal perspectives. Results: From a societal perspective, the incremental cost was US$3,485.28 (US$80,245.48 (non-SGLT2i) and US$83,730.76 (SGLT2i)), and US$2,971.00 (US$80,913.73 (non-SGLT2i) and US$83,884.73 (SGLT2i)) in patients with renal replacement therapy (RRT) and without RRT, respectively. The incremental QALY were 2.73 (13.88 (non-SGLT2i) and 16.61 years (SGLT2i)) and 2.79 years (13.78 (non-SGLT2i) and 16.57 years (SGLT2i)) in patients with RRT and without RRT, respectively. ICERs were US$1,276.66 and US$1,064.87 per QALY in patients with and without RRT, respectively. A one-way sensitivity analysis suggested that the admission cost per day had the biggest impact on the ICER. Although SGLT2is are more expensive than alternatives, they remain cost-effective at the Thai willingness to pay threshold of US$4,869 per QALY. Conclusion: This finding was robust in multiple sensitivity analyses, showing consistent net benefit regardless of RRT status. Future research should now focus on differentiating the value of specific drugs within the class. Clinical trial number: Not applicable.