Adding Dapagliflozin to CKD Standard of Care Would Cut Costs by Millions

The use of Farxiga (dapagliflozin) in addition to standard-of-care therapy in patients with chronic kidney disease (CKD) not only leads to improved outcomes for patients, but also translates into tens of millions of dollars in lower health care spending for the patient population, according to a new report.

Dapagliflozin is a sodium-glucose co-transporter 2 inhibitor that was initially approved to treat patients with type 2 diabetes (T2D). In 2020, investigators published the results of the DAPA-CKD study, which looked at the drug’s impact on renal outcomes and cardiovascular mortality in patients with CKD, with or without T2D.

The results were dramatic. Compared with placebo, patients given the medication saw significant reductions in the incidence of 50% or greater decline in estimated glomerular filtration rate (eGFR), as well as drops in rates of end-stage renal disease (ESRD) and death from renal or cardiovascular causes. The impacts were so dramatic that the study was ended prematurely due to overwhelming efficacy.

In a poster presented at the Academy of Managed Care Pharmacy’s 2021 meeting, investigators sought to determine just how this high level of efficacy would impact the cost of care for patients with CKD based on costs of care in the United States. They used event rates from DAPA-CKD to predict the likelihood of those events occurring over a 1-year period. They then used published costs of health care claims to determine the costs of care associated with the patient pool.

The analysis showed that, over the course of a year, treating those patients with dapagliflozin plus standard-of-care therapy would result in 1321 instances of at least a 50% decline in eGFR. By comparison, over the same time period, utilizing only the standard-of-care treatment would see 2414 cases of at least a 50% decline in eGFR (number needed to treat [NNT]: 47).

In terms of ESRD, the analysis suggested that treating patients with dapagliflozin would result in 1271 incidences vs 1919 instances if dapagliflozin were not included in the therapy (a decline of 648 incidences; NNT: 79).

The model showed that 407 hospitalizations for heart failure could be avoided using dapagliflozin (410 events with dapagliflozin vs 817 without; NNT: 127) and that 451 fewer deaths would occur in the patient population (1120 vs 1571; NNT: 114).

Those improvements in care would lead to significant cost savings, the investigators found. In a population based on the DAPA-CKD inclusion criteria, health care costs would drop by one-third, or $99.1 million, as a result of dapagliflozin; for those under the age of 65, costs would drop by $121.8 million (37%); and in patients 65 or older, the total costs would drop by an estimated $122.6 million (26%) vs standard of care.

All told, the investigators said the drug would have a significant economic impact if used regularly with the standard of care and if the data from the DAPA-CKD study held true on a population basis.

“Dapagliflozin significantly reduces health care resource utilization in patients with CKD through delayed CKD progression and reduced event incidence, helping to ameliorate the significant burden imposed by CKD on both patients and payers,” they concluded.

Reference

McEwan P, Darlington O, Miller R, et al. Translating the findings of DAPA-CKD to reductions in healthcare resource utilization from a U.S. payer perspective. Presented at: Academy of Managed Care Pharmacy 2021; April 12-16, 2021. Abstract N1.