Cost-effectiveness of sodium-glucose cotransporter-2 inhibitors in the treatment of diabetic nephropathy in Japan

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2024-09-30 DOI:10.1111/dom.15832

Keiko Maruyama-Sakurai MPH, Hisateru Tachimori PhD, Eiko Saito PhD, Shun Kohsaka MD, Yasumasa Segawa MPH, Hiroaki Miyata PhD, Ataru Igarashi PhD

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Abstract

Aim

To assess the cost-effectiveness of diabetic nephropathy treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors in Japanese clinical practice, considering diabetes-related complications.

Materials and Methods

A population-based Monte Carlo simulation was used to estimate the cost-effectiveness for people with diabetic nephropathy who initiated pharmacotherapy with an SGLT2 inhibitor plus conventional treatment or conventional treatment alone, based on quality-adjusted life-years (QALYs) and healthcare costs. The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation study (CREDENCE) and the Japanese Society for Dialysis Research statistical survey were the primary sources of probability and mortality, while Japanese Health Insurance Claims Data were the cost source. The state transition model included diabetic nephropathy, hospitalization due to cardiovascular disease, dialysis, and death. One-way and probabilistic sensitivity analyses were used to explore model uncertainty.

Results

Using the threshold of JPY 5 000 000 per QALY, SGLT2 inhibitor plus conventional treatment was more cost-effective than conventional treatment alone, with an incremental cost-effectiveness ratio of JPY 654 309 per QALY. Treating 100 000 people, SGLT2 inhibitor plus conventional treatment prevented 2234 deaths and reduced 5793 fewer heart failure cases, 3967 fewer myocardial infarctions and stroke events. Sensitivity analysis affirmed the robustness of these results for patients aged under 70 years.

Conclusions

The SGLT2 inhibitor treatment appeared to be cost-effective for the overall population of our study and particularly for younger patients (<70 years old). For older patients (≥70 years old), the cost-effectiveness was less clear and may require further evaluation. Decision-makers should consider this age-based heterogeneity when making recommendations about SGLT2 inhibitor treatment.

Abstract Image

查看原文本刊更多论文

日本钠-葡萄糖共转运体-2 抑制剂治疗糖尿病肾病的成本效益。

目的：考虑到糖尿病相关并发症，评估在日本临床实践中使用钠-葡萄糖共转运体-2（SGLT2）抑制剂治疗糖尿病肾病的成本效益：基于质量调整生命年（QALYs）和医疗成本，采用基于人群的蒙特卡洛模拟法估算了糖尿病肾病患者在开始接受 SGLT2 抑制剂加常规治疗或单纯常规治疗的药物治疗后的成本效益。概率和死亡率的主要数据来源是卡格列净和糖尿病肾病患者肾脏事件临床评估研究（CREDENCE）和日本透析研究学会统计调查，而成本来源则是日本健康保险索赔数据。状态转换模型包括糖尿病肾病、心血管疾病住院、透析和死亡。采用单向和概率敏感性分析来探讨模型的不确定性：以每 QALY 5 000 000 日元为临界值，SGLT2 抑制剂加常规治疗比单纯常规治疗更具成本效益，增量成本效益比为每 QALY 654 309 日元。治疗 10 万人，SGLT2 抑制剂加常规治疗可预防 2234 例死亡，减少 5793 例心衰病例，减少 3967 例心肌梗死和中风事件。敏感性分析证实了这些结果对70岁以下患者的稳健性：SGLT2抑制剂治疗对我们研究的总体人群，尤其是对年轻患者而言，似乎具有成本效益（见图1）。

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

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.