Cost-Effectiveness Analysis of Dapagliflozin for People With Chronic Kidney Disease: A Case for Malaysia

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of dapagliflozin as an add-on to standard of care (SoC) in people with chronic kidney disease (CKD) in Malaysia.

METHODS: A Markov model was adapted to estimate the economic and clinical benefits of dapagliflozin in individuals with CKD stages 2 to 5. The model incorporated data from the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, supplemented with local cost and utility data.

RESULTS: In Malaysia, adding dapagliflozin to SoC was found to be economically dominant compared to SoC alone, with costs of RM 81,814 versus RM 85,464 (USD 19,762 vs USD 20,644), respectively. Dapagliflozin increased life expectancy by 0.46 years and quality-adjusted life years (QALYs) by 0.41 compared to SoC alone (10.01 vs. 9.55 years, 8.76 vs. 8.35 QALYs). This corresponded to a cost saving of RM 8,894 (USD 2,148) per QALY gained. The economic benefits stemmed from delayed CKD progression, resulting in reduced costs associated with dialysis and renal transplantation. Sensitivity analyses confirmed the robustness of these findings across various assumptions and subgroups, all remaining below the accepted willingness-to-pay threshold of RM 46,000/QALY.

CONCLUSIONS: The use of dapagliflozin as an adjunct to SoC in CKD patients in Malaysia was projected to enhance both life expectancy and quality of life while providing significant cost savings. Specifically, dapagliflozin yielded savings of RM 8,894 (USD 2,148) per QALY gained and RM 7,898 (USD 1,908) per life year gained. These findings underscore dapagliflozin as a promising therapeutic option for improving outcomes and reducing economic burden in CKD management.