medwireNews: Adding canagliflozin to current standard of care (SoC) improves survival, increases quality-adjusted life–years (QALYs), and reduces treatment costs for people with type 2 diabetes treated in England over a 10-year period, research suggests.
The findings are based on a microsimulation model (CREDEM-DKD) that was developed using patient-level data from the CREDENCE trial, the results of which led to canagliflozin 100 mg/day receiving an extension to its EU marketing authorization in July 2020 to include the treatment of diabetic kidney disease (DKD) in people with poorly controlled type 2 diabetes.
Michael Willis (The Swedish Institute for Health Economics, Lund) and co-investigators say this approval made canagliflozin “the first pharmacological therapy to receive regulatory authorization for treatment of DKD since the RENAAL and IDNT trials in nearly 20 years.”
The researchers report in Diabetes Therapy that the clinical benefits associated with canagliflozin use, such as the preservation of estimated glomerular filtration rate and reductions in urinary albumin-to-creatinine ratio, dialysis, cardiovascular events, and mortality, lead to gains of 0.27 life–years per patient over 10 years, along with 0.28 more QALYs and cost savings of £ 4706 (US$ 6326; € 5180) per patient.
The CREDEM-DKD model suggested that the cost savings are mainly driven by reductions in dialysis (£ 2754 [$ 3702; € 3031]) and progression to stage 4 (£ 2372 [$ 3189; € 2611]) or stage 5 (£ 2256 [$ 3031; € 2482]) DKD.
There were also canagliflozin-associated cost savings for heart failure (£ 206 [$ 277; € 227]), myocardial infarction (£ 45 [$ 60; € 50]), and stroke (£ 19 [$ 26; €21]), but Willis et al note that the reduction in these events “was partially offset by increased survival and longer exposure to the risks.”
The investigators found that the model had a low degree of uncertainty, with their analysis suggesting that there was a 96% chance of canagliflozin plus SoC costing less than SoC alone at a willingness-to-pay threshold of £ 0 per QALY.
When the willingness-to-pay threshold was increased to £ 30,000 ($ 40,249; € 32,990) per QALY, as typically used by the UK National Institute for Health and Care Excellence, the probability of cost-effectiveness reached 99%.
Willis and co-authors conclude: “Model-based extrapolation of the renal and cardiovascular benefits demonstrated in the CREDENCE trial to 10 years suggests that canagliflozin, used as adjunct to SoC with maximal tolerated doses of a [renin–angiotensin–aldosterone system] inhibitor, can substantially reduce rates of renal and cardiovascular outcomes, and increase longevity and QALYs versus SoC alone in this high unmet need population in England, while managing to reduce total costs in the process.”
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