896-P: Dapagliflozin Cost Offsets in Chronic Kidney Disease for Commercial U.S. Payers

Abstract

One in 7 adults have chronic kidney disease (CKD) , which is associated with high mortality and costly healthcare resource utilization (HCRU) . Data from a US employer-sponsored health insurance plan show rising per-member-per-year costs for treatment of cardiac and renal complications associated with CKD. A cost-offset model (COM) was deployed to quantify the predicted clinical and economic benefits of treatment with dapagliflozin. The COM used real-world cost and member count data from a US employer-sponsored commercial payer and the phase 3 DAPA-CKD (NCT03036150) clinical trial event rates for outcomes, including ≥ 50% decline in estimated glomerular filtration rate (eGFR) , end-stage kidney disease (ESKD) , and hospitalization for heart failure (HHF) . HCRU cost-offsets were calculated over a 3-year time horizon in a population of 130 members with CKD stages 2-4 who were modeled for treatment with either dapagliflozin plus standard of care (SOC) or SOC alone. Over a 3-year period, 9 instances of ≥ 50% decline in eGFR were estimated for treatment with dapagliflozin versus (vs.) 15 with SOC (6 fewer events; number needed to treat [NNT]: 20) , amounting to estimated cumulative cost-offsets of $0.57 million (M) . Similarly, 6 ESKD events were avoided with dapagliflozin vs. SOC (8 vs. 14; NNT: 24) , resulting in $1.92 M in cumulative cost-offsets. Dapagliflozin use also avoided 20 HHF events compared with SOC (13 vs. 33; NNT: 7) , totaling $0.79 M in cumulative cost-offsets. Overall, better clinical outcomes translated into total cumulative HCRU cost-offsets of $3.89 M (36.6% reduction in favor of dapagliflozin + SOC vs. treatment with SOC alone) . Results of our COM estimate that dapagliflozin greatly decreases HCRU costs in plan members with CKD by reducing cardiac and renal clinical events over a 3-year period. Modeling these outcomes for members with CKD with and without type 2 diabetes demonstrates that dapagliflozin can be a cost-effective way to reduce HCRU costs associated with CKD for commercial payers. Disclosure R.Chang: Employee; AstraZeneca, UnitedHealth Group. J.Huang: Employee; AstraZeneca. D.Reck: None. J.Hurst: Employee; AstraZeneca. K.Wolf khachatourian: Consultant; Bayer AG, Xcenda. M.H.Shannon: Consultant; Bayer AG, Speaker's Bureau; Bayer AG, Novo Nordisk A/S. Funding AstraZeneca