Cost Offset of Dapagliflozin in the US Medicare Population with Cardio-Kidney Metabolic Syndrome

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Advances in Therapy Pub Date : 2024-07-03 DOI:10.1007/s12325-024-02919-5

Raymond C. Chang, Ryan L. Miller, Katherine W. Kwon, Joanna C. Huang

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Abstract

Introduction

Cardiovascular-kidney-metabolic (CKM) syndrome is highly prevalent in the US Medicare population and is projected to increase further. Sodium-glucose co-transporter 2 inhibitors have indications in chronic kidney disease (CKD), heart failure (HF), and type 2 diabetes (T2D), providing protective efficacy across conditions within CKM syndrome. The objective of this study was to develop a model to extrapolate key outcomes observed in pivotal clinical trials to the US Medicare population, and to assess the potential direct cost offsets associated with dapagliflozin therapy.

Methods

All US 2022 Medicare beneficiaries (≥ 65 years of age) eligible to receive dapagliflozin were estimated according to drug label indication and Medicare enrollment and claims data. Incidence of key outcomes from the dapagliflozin clinical program were modelled over a 4-year time horizon based on patient-level data with CKD, HF, and T2D. Published cost data of relevant clinical outcomes were used to calculate direct medical care cost-offset associated with treatment with dapagliflozin.

Results

In a population of 13.1 million patients with CKM syndrome, treatment with dapagliflozin in addition to historical standard of care (hSoC) versus hSoC alone led to fewer incidents of HF-related events (hospitalization for HF, 613,545; urgent HF visit, 98,896), renal events (kidney failure, 285,041; ≥ 50% sustained decline in kidney function, 375,137), and 450,355 fewer deaths (of which 225,346 and 13,206 incidences of cardiovascular and renal death were avoided). In total this led to medical care cost offsets of $99.3 billion versus treatment with hSoC only (dapagliflozin plus hSoC, $310.3 billion; hSoC, $211.0 billion).

Conclusion

By extrapolating data from trials across multiple indications within CKM syndrome, this broader perspective shows that considerable medical care cost offsets may result through attenuated incidence of clinical events in CKD, T2D, and HF populations if treated with dapagliflozin in addition to hSoC over a 4-year time horizon.

Graphical abstract available for this article.

Graphical Abstract

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达帕格列净在患有心肾代谢综合征的美国医疗保险人群中的成本抵消。

导言：心血管-肾脏-代谢（CKM）综合征在美国医疗保险人群中发病率很高，而且预计还会进一步增加。钠-葡萄糖协同转运体 2 抑制剂适用于慢性肾脏病 (CKD)、心力衰竭 (HF) 和 2 型糖尿病 (T2D)，在 CKM 综合征的各种病症中具有保护作用。本研究的目的是建立一个模型，将关键临床试验中观察到的主要结果推断到美国医疗保险人群中，并评估与达帕格列净治疗相关的潜在直接成本抵消：根据药物标签上的适应症以及医疗保险的注册和理赔数据，估算了所有符合达帕格列净治疗条件的美国 2022 名医疗保险受益人（年龄≥ 65 岁）。根据患有 CKD、HF 和 T2D 的患者水平数据，对 4 年时间跨度内达帕格列净临床项目主要结果的发生率进行建模。已公布的相关临床结果的成本数据被用来计算与达帕格列净治疗相关的直接医疗成本抵消：结果：在 13.结果表明：在 1,300,000 名 CKM 综合征患者中，在使用传统标准疗法 (hSoC) 的同时使用达帕格列净治疗与仅使用 hSoC 相比，可减少心房颤动相关事件的发生（因心房颤动住院，613,545 人次；因心房颤动急诊，98,845 人次）；肾衰竭，285,041 例；肾功能持续下降≥ 50%，375,137 例），死亡人数减少 450,355 例（其中避免了 225,346 例心血管死亡和 13,206 例肾脏死亡）。与仅使用 hSoC 相比，总计可抵消医疗成本 993 亿美元（达帕利氟嗪加 hSoC，3103 亿美元；hSoC，2110 亿美元）：通过对 CKM 综合征中多个适应症的试验数据进行推断，这一更广阔的视角表明，在 4 年的时间跨度内，如果在使用 hSoC 的同时使用达帕格列净治疗 CKD、T2D 和 HF 患者，由于临床事件的发生率降低，可能会产生可观的医疗成本补偿。本文有图表摘要。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.