Evaluación de eventos clínicos y costes asociados a la adición de dapagliflozina al tratamiento de la enfermedad renal crónica: análisis de compensación de costes

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia Pub Date : 2024-11-01 DOI:10.1016/j.nefro.2024.05.010

Juan Francisco Navarro-González , Alberto Ortiz , Ana Cebrián Cuenca , Lluís Segú , Belén Pimentel , Unai Aranda , Blanca Lopez-Chicheri , Margarita Capel , Elisenda Pomares Mallol , Christian Caudron , Juan José García Sánchez , Roberto Alcázar Arroyo

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引用次数: 0

Abstract

Background and objectives

Chronic kidney disease (CKD) is a serious health problem with an increasing clinical, social and economic impact in advanced stages. Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor that reduces the risk of CKD progression, in addition to provide cardiovascular benefits and reduce all-cause mortality. The aim of this study was to determine the short-term clinical and economic impact of dapagliflozin as an add-on to renin-angiotensin-aldosterone system inhibitors (RAASi) standard therapy for CKD in Spain.

Materials and methods

A cost-offset model was used to compare the costs of clinical events and pharmacological per 100,000 CKD patients in a virtual cohort treated with dapagliflozin added to RAASi standard therapy versus RAASi standard therapy alone. Renal (progression to renal failure and acute kidney injury), cardiovascular (hospitalisation for heart failure [HF]), and all-cause mortality events were assessed. The incidence of clinical events by treatment arm was obtained from the DAPA-CKD study, and costs were obtained from national databases and the literature.

Results

Over 3 years, treatment with dapagliflozin would reduce progression to renal failure (−33%; 7,221 vs. 10,767), hospitalisation for HF (−49%; 2,370 vs. 4,683) and acute kidney injury (−29%; 4,110 vs. 5,819). The savings associated with this reduction in events was €258 million per 100,000 patients, of which 63.4% is due to the avoidance of dialysis for renal failure. Considering the event and pharmacological treatment costs, the total net savings were estimated at €158 million per 100,000 patients.

Conclusions

Delaying progression of CKD and reducing the incidence of clinical events thanks to the treatment with dapagliflozin could generate savings for the Spanish National Health System, even when pharmacological costs are taken into account.

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评估在慢性肾病治疗中添加达帕格列净的相关临床事件和成本：成本权衡分析

背景和目的慢性肾脏病（CKD）是一个严重的健康问题，晚期患者的临床、社会和经济影响越来越大。达帕格列净是一种钠-葡萄糖共转运体-2抑制剂，可降低慢性肾脏病进展的风险，此外还可为心血管带来益处并降低全因死亡率。本研究旨在确定达帕格列净作为肾素-血管紧张素-醛固酮系统抑制剂（RAASi）标准疗法的附加疗法对西班牙 CKD 患者的短期临床和经济影响。材料和方法采用成本抵消模型，比较虚拟队列中每 10 万名接受达帕格列净附加 RAASi 标准疗法与单独 RAASi 标准疗法治疗的 CKD 患者的临床事件和药物治疗成本。对肾脏（进展为肾衰竭和急性肾损伤）、心血管（因心衰 [HF] 而住院）和全因死亡率事件进行了评估。各治疗组的临床事件发生率来自 DAPA-CKD 研究，费用来自国家数据库和文献。结果在 3 年内，使用达帕格列净治疗可减少肾衰竭进展（-33%；7221 对 10767）、心力衰竭住院（-49%；2370 对 4683）和急性肾损伤（-29%；4110 对 5819）。每 10 万名患者中，因事件减少而节省的费用为 2.58 亿欧元，其中 63.4% 是由于避免了因肾衰竭而进行透析。结论达帕格列净治疗可延缓慢性肾脏病的进展并降低临床事件的发生率，即使考虑到药物治疗成本，也可为西班牙国家卫生系统节省开支。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nefrologia 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

7.70%

发文量

148

审稿时长

47 days

期刊介绍： Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.