OBJECTIVES: Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor inhibitors (ARBs) have been used as standard of care (SoC) for the treatment of diabetes nephropathy (DN) in the United States. Dapagliflozin and saxagliptin have shown to reduce progression of diabetes kidney disease when they are added to the SoC. The present study aimed to determine the cost-effectiveness of dapagliflozin or dapagliflozin plus saxagliptin added to the SoC in diabetes patients with diabetic kidney disease.

METHODS: A validated Markov model was adopted from the CORE diabetic model to determine the cost-utility outcomes from the United States health care perspective. Model inputs were derived from the literature. Our primary outputs were the total costs of interventions, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analysis were performed to assess the potential uncertainties of parameters. A willingness to pay threshold of $60,000 per QALY was used based on the United States’ per capita GDP 2021.

RESULTS: Among the three interventions, dapagliflozin yielded superior effectiveness in terms of improving the QALY by 2.9. The discounted QALY associated with the SoC and dapagliflozin-saxagliptin was 2.7. The SoC was the cheapest treatment (life-time cost: $56,015.90). Dapagliflozin demonstrated ICER of 9179.71 per additional QALY gained as compared to the SoC. Dapagliflozin-saxagliptin was absolutely dominated. The most influential parameters of the ICER were the ADR cost of SoC, the acquisition cost and ADR-related cost of dapagliflozin whereas the outcomes were not sensitive to changes in utilities and disutility. The effects and costs of all interventions were consistent between the deterministic and probabilistic model.

CONCLUSIONS: Our study highlighted that dapagliflozin was cost-effective alternative relative to the standard treatment alone in the United States for patients with Diabetes nephropathy. Hence, dapagliflozin could be considered as add-on therapy to the SoC in these patients.