Cost Effectiveness of Dapagliflozin Added to Standard of Care for the Management of Diabetic Nephropathy in the USA.

Abstract

Angiotensin-converting enzyme inhibitors have been used as the standard of care for the treatment of diabetic nephropathy. Recently, dapagliflozin has been shown to reduce diabetic nephropathy when added to the standard of care. The objective of this study was to determine the cost effectiveness of dapagliflozin added to the standard of care in diabetic nephropathy in the United States of America (USA). A Markov model was developed to determine the cost-effectiveness outcomes from the Medicare/Medicaid health coverage perspective. Model inputs were derived from the literature. The primary outcomes were total costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were performed to determine the robustness of our results. A willingness-to-pay threshold of $100,000 per QALY was applied, which is based on previous studies. Dapagliflozin yielded a lifetime QALY of 2.8. The discounted QALY associated with the standard of care was 2.6. The standard of care was the less costly treatment with a lifetime cost of $106,150.25 as compared with dapagliflozin, which costs $110,689.25. Dapagliflozin demonstrated an incremental cost-effectiveness ratio of $21,141.51 per additional QALY. The most influential parameters of the incremental cost-effectiveness ratio were the adverse drug reaction-related cost of the standard of care and dapagliflozin, the acquisition cost, and the adverse drug reaction-related cost of dapagliflozin. The effects and costs of the interventions were consistent between base-case analyses and the probabilistic model (incremental cost-effectiveness ratio: $19,023.35 [$13,637.8-$27,483.1]). Dapagliflozin added to the standard of care was cost effective relative to the standard of care alone in the USA for patients with diabetic nephropathy.