{"title":"The cost-effectiveness of second line diabetes medication added to standard therapy in preventing type 2 diabetes related nephropathy in Germany.","authors":"Hanni Hille, Wendelin Schramm, Ahmed Bounekkar","doi":"10.1186/s12962-026-00801-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes and its associated complications like nephropathy impose a serious burden on health systems. Several blood glucose-lowering medications have shown to be likely to provide nephroprotective properties, delaying or preventing the onset of kidney damage. Kidney-specific health-economic evaluations, comparing different agents, remain rare for Germany.</p><p><strong>Methods: </strong>A Markov-microsimulation model was developed to obtain the perspective of the German statutory health system regarding cost-effectiveness. The model consists of five health states representing varying degrees of kidney damage with transition probabilities, utilities and costs being taken from published literature. Patient age was set to 62.8 years in the primary cohort; an additional analysis scenario was created with a start age of 50 years. The model outcomes life expectancy, quality adjusted life years, costs and net monetary benefit were discounted at 3% at a willingness-to-pay threshold of 100,000€ per quality adjusted life year gained.</p><p><strong>Results: </strong>Quality adjusted life years increased from 10.28 years in standard care to 10.48 years with Empagliflozin, 10.58 years with Semaglutide and 10.75 years with Tirzepatide all added on top of standard care. Life expectancy increased from 13.36 years in the base case to 13.66 years, 13.76 years and 14.00 years with Empagliflozin, Semaglutide and Tirzepatide respectively. Total direct cost amounted to 66,343.64€ in the base case, 79,767.42€ with Empagliflozin, 84,328.59€ with Semaglutide and to 155,992.59€ with Tirzepatide. The net monetary benefit was calculated to be 961,445.98€ in the base case, 968,406.95€, 973,647.74€ and 919,972.95€ with Empagliflozin, Semaglutide and Tirzepatide respectively. Multiple one-way sensitivity analyses were performed. The most influencing factors on the cost-effectiveness were found to be quality of life in the type 2 diabetes state and intervention cost.</p><p><strong>Conclusion: </strong>In this study, the application of second-line glucose-lowering medication in type 2 diabetes patients led to relevant medical improvements regarding kidney damage at higher expenditures. At the chosen willingness-to-pay threshold Empagliflozin and Semaglutide remained cost-effective in all scenarios. Patient age and sex did not change the health-economic implications.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"24 1","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404957/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cost Effectiveness and Resource Allocation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12962-026-00801-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
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Abstract
Background: Type 2 diabetes and its associated complications like nephropathy impose a serious burden on health systems. Several blood glucose-lowering medications have shown to be likely to provide nephroprotective properties, delaying or preventing the onset of kidney damage. Kidney-specific health-economic evaluations, comparing different agents, remain rare for Germany.
Methods: A Markov-microsimulation model was developed to obtain the perspective of the German statutory health system regarding cost-effectiveness. The model consists of five health states representing varying degrees of kidney damage with transition probabilities, utilities and costs being taken from published literature. Patient age was set to 62.8 years in the primary cohort; an additional analysis scenario was created with a start age of 50 years. The model outcomes life expectancy, quality adjusted life years, costs and net monetary benefit were discounted at 3% at a willingness-to-pay threshold of 100,000€ per quality adjusted life year gained.
Results: Quality adjusted life years increased from 10.28 years in standard care to 10.48 years with Empagliflozin, 10.58 years with Semaglutide and 10.75 years with Tirzepatide all added on top of standard care. Life expectancy increased from 13.36 years in the base case to 13.66 years, 13.76 years and 14.00 years with Empagliflozin, Semaglutide and Tirzepatide respectively. Total direct cost amounted to 66,343.64€ in the base case, 79,767.42€ with Empagliflozin, 84,328.59€ with Semaglutide and to 155,992.59€ with Tirzepatide. The net monetary benefit was calculated to be 961,445.98€ in the base case, 968,406.95€, 973,647.74€ and 919,972.95€ with Empagliflozin, Semaglutide and Tirzepatide respectively. Multiple one-way sensitivity analyses were performed. The most influencing factors on the cost-effectiveness were found to be quality of life in the type 2 diabetes state and intervention cost.
Conclusion: In this study, the application of second-line glucose-lowering medication in type 2 diabetes patients led to relevant medical improvements regarding kidney damage at higher expenditures. At the chosen willingness-to-pay threshold Empagliflozin and Semaglutide remained cost-effective in all scenarios. Patient age and sex did not change the health-economic implications.
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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