Cost-Utility Analysis of Empagliflozin on Chronic Kidney Disease Progression in Patients With Chronic Kidney Disease in Thailand

OBJECTIVES: Empagliflozin has been known as an effective treatment to slow kidney disease progression in patients with chronic kidney disease (CKD). However, no cost-effectiveness study has been conducted. This study aimed to assess the cost-effectiveness of empagliflozin as an add-on treatment to the standard of care (SoC) for CKD progression in Thailand.

METHODS: A state-transition model was developed consisting of eight health states: five eGFR health states (G2, G3a, G3b, G4, and G5), dialysis, kidney transplantation, and death. Empagliflozin 10 milligrams was assessed as an add-on treatment to SoC. The efficacy of empagliflozin was derived from the EMPA-KIDNEY trial, while other inputs were obtained from a comprehensive literature review of local Thai data. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) was calculated separately for CKD patients with or without diabetes mellitus (DM). A probabilistic sensitivity analysis (PSA) was performed to explore uncertainties.

RESULTS: Empagliflozin could improve QALYs by 0.71 and 0.62 for CKD patients with and without DM compared to SoC, respectively. However, it required higher total lifetime costs of 59,454 Thai baht (THB) and 77,966 THB for CKD patients with and without DM. The ICER for CKD with DM was 83,473 THB/QALY, while the ICER for CKD without DM was 126,201 THB/QALY. The PSA indicated that empagliflozin had an 89.18% probability of being cost-effective for CKD with DM and a 64.00% probability for CKD without DM.

CONCLUSIONS: At the current willingness-to-pay threshold of 160,000 THB/QALY, empagliflozin was cost-effective for treating CKD patients with or without DM.

DISCLOSURE STATEMENT: "The EMPA-KIDNEY trial was initiated, designed, and conducted by the University of Oxford in collaboration with a Steering Committee of experts and Boehringer Ingelheim. The presented analyses were initiated and conducted independently from the EMPA-KIDNEY Collaborative Group".