A cost-utility analysis of adding SGLT2 inhibitors for the management of type 2 diabetes with chronic kidney disease in Thailand

Abstract

Chronic kidney disease (CKD) in type 2 diabetes (T2D) patients is associated with end-stage renal disease and significant economic burden. While sodium glucose cotransporter-2 inhibitors (SGLT2i) show renal benefits in randomized controlled trials (RCTs), their cost-effectiveness in Thailand remains unclear. This study evaluates the cost-utility of adding SGLT2i (dapagliflozin, empagliflozin, and canagliflozin) to standard of care therapy (SoCT) for T2D patients with CKD in Thailand. A lifetime Markov model assessed economic and clinical outcomes. Data were derived from Thai studies, RCT subgroup analyses, and patient interviews. Sensitivity analysis was performed. Adding SGLT2i increased life expectancy (0.42-0.52 years) and QALYs (3.83- 3.91 vs. 3.50 with SoCT alone), but also increased lifetime costs ($1,275–$1,903). Empagliflozin was cost-effective at a WTP threshold of $4,336 per QALY ($3,386/QALY), while dapagliflozin ($5,783/QALY) and canagliflozin ($4,591/QALY) required price reductions. SGLT2i showed potential cost savings for dialysis and kidney transplantation compared to SoCT alone. Adding SGLT2i to SoCT for T2D and CKD patients increases costs but provides significant clinical benefits. Empagliflozin is cost-effective at a WTP threshold of $4,336/QALY, while dapagliflozin and canagliflozin require price reductions to be cost-effective. However, the analysis solely focuses on renal benefits, excluding other advantages like cardiovascular and heart failure protection.