Mo876estimating the budget impact of dapagliflozin for the treatment of chronic kidney disease from a uk payer perspective*

Abstract Background and Aims Chronic kidney disease (CKD) is a chronic and progressive disease which imposes a significant burden on patients and healthcare systems as the disease progresses, particularly in patients who reach end-stage kidney disease (ESKD). Dapagliflozin was established to be an efficacious treatment for CKD in the DAPA-CKD study, where it was associated with a significant reduction in the incidence of CKD progression, ESKD, hospitalization for heart failure (HHF) and death in comparison with standard care alone. A vital component of a new treatment's health economic evaluation is to assess its potential budget impact, particularly in conditions with high prevalence in the general population such as CKD. As such, this study's objective was to estimate the budget impact of introducing dapagliflozin for the treatment of CKD in the UK from an NHS perspective. Method A model was developed to estimate the three-year budget impact of the introduction of dapagliflozin in addition to standard care (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) vs. standard care alone for the treatment of CKD in the UK. The size of the eligible patient population was estimated based on overall CKD prevalence, and the proportion of all CKD patients who would have been eligible for inclusion in DAPA-CKD. In total, 929,000 patients were estimated to be eligible for treatment with dapagliflozin in the UK. The analysis assumed that 5% of CKD patients would receive treatment with dapagliflozin in the first year, increasing to 15% in the second year and 20% in the third year. The relative market share of individual components of background standard care was assumed to remain constant over time, with the distribution informed by the baseline characteristics from DAPA-CKD. Event rates from DAPA-CKD were used to predict the incidence of CKD progression (≥50% decline in estimated glomerular filtration rate), ESKD, HHF, acute kidney injury, hyperkalaemia and death to estimate cost-offsets associated with reduced event incidence. Published event and drug acquisition costs were applied to the incidence of modelled events. Results The introduction of dapagliflozin was estimated to reduce total three-year costs associated with CKD management by £114.0M, from £6.6B to £6.5B in the patient population eligible for treatment with dapagliflozin. Cost-savings were driven by a reduction in the incidence of CKD progression events (122.7K vs. 130.5K with and without the introduction of dapagliflozin, respectively), ESKD (99.2K vs. 103.8K) and HHF (44.2K vs. 41.3K) over a three-year time horizon. Cumulative three-year drug acquisition costs were estimated to increase by £177.4M following the introduction of dapagliflozin when used in addition to standard care. However, the cumulative cost-offsets associated with reduced incidence of clinical events was £291.3M over the three-year model time horizon, with reduced incidence of ESKD resulting in the largest cost-saving (£4.8B vs. £5.0B). Conclusion The introduction of dapagliflozin for the treatment of CKD is estimated to be cost-saving over a three-year horizon in comparison with standard care, even when considering additional drug acquisition costs. Dapagliflozin has the potential to significantly ameliorate the clinical and economic burden imposed by CKD on patients and the NHS.