Quantifying Spillover Impacts: Effect of Novel Therapies for IgA Nephropathy on Patients Awaiting Kidney Transplant
Author(s)
Jaehong Kim, PhD1, Jacob Fajnor, MS1, Jason Shafrin, PhD1, Briana C. Ndife, MPH2, Helen Trenz, MS2, Titte R. Srinivas, MD, MBA2, Ajay Israni, PhD3;
1FTI Consulting, Los Angeles, CA, USA, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 3University of Texas, Galveston, TX, USA
1FTI Consulting, Los Angeles, CA, USA, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 3University of Texas, Galveston, TX, USA
Presentation Documents
OBJECTIVES: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a leading cause of chronic kidney disease. Novel IgAN therapeutics may slow disease progression, thereby reducing kidney transplant demand. This study quantified health economic benefits of IgAN interventions for patients receiving these therapies, and their impact on US kidney transplant waitlist candidates.
METHODS: Two health economic modeling frameworks were implemented. First, a Markov model was used to estimate health benefits accrued among adults with high-risk IgAN receiving IgAN interventions. Second, the results were inputted into a double queuing model to quantify the additional value (“spillover benefits”) of IgAN interventions accrued by all candidates on the deceased donor kidney transplant waitlist. Both models adopted a patient lifetime horizon of 70 years. IgAN interventions included therapies with FDA approval or phase 3 proteinuria reduction results (targeted-release budesonide, sparsentan, iptacopan, dapagliflozin, and atrasentan) in addition to nonspecific IgAN therapies (including renin-angiotensin-aldosterone system inhibitors and systemic corticosteroids); the comparator was nonspecific IgAN therapies alone. Outcomes included reduction in transplant demand (average number of kidneys saved annually), transplant wait time, life-years gained, and QALYs gained. A willingness-to-pay of US$150,000 was used to monetize QALY benefits.
RESULTS: IgAN interventions lowered kidney transplant demand in affected patients by 33.4% (average 669 kidneys/year). Transplant wait time decreased by 25 days per candidate, yielding an additional 0.063 life-years and 0.087 QALYs (monetized benefit US$13,116) per candidate. Applied to the current US kidney transplant waitlist, IgAN interventions generated 7864 QALYs (monetized benefit US$1.2 billion) and reduced waitlist size by 2138 candidates within 5 years. Finally, 1.77 QALYs were generated per treated patient with IgAN, 23% of which were attributable to spillover benefit.
CONCLUSIONS: IgAN interventions may provide health benefits beyond the direct clinical benefits to affected patients. These additional societal benefits should be considered when conducting value assessment of novel IgAN treatments.
METHODS: Two health economic modeling frameworks were implemented. First, a Markov model was used to estimate health benefits accrued among adults with high-risk IgAN receiving IgAN interventions. Second, the results were inputted into a double queuing model to quantify the additional value (“spillover benefits”) of IgAN interventions accrued by all candidates on the deceased donor kidney transplant waitlist. Both models adopted a patient lifetime horizon of 70 years. IgAN interventions included therapies with FDA approval or phase 3 proteinuria reduction results (targeted-release budesonide, sparsentan, iptacopan, dapagliflozin, and atrasentan) in addition to nonspecific IgAN therapies (including renin-angiotensin-aldosterone system inhibitors and systemic corticosteroids); the comparator was nonspecific IgAN therapies alone. Outcomes included reduction in transplant demand (average number of kidneys saved annually), transplant wait time, life-years gained, and QALYs gained. A willingness-to-pay of US$150,000 was used to monetize QALY benefits.
RESULTS: IgAN interventions lowered kidney transplant demand in affected patients by 33.4% (average 669 kidneys/year). Transplant wait time decreased by 25 days per candidate, yielding an additional 0.063 life-years and 0.087 QALYs (monetized benefit US$13,116) per candidate. Applied to the current US kidney transplant waitlist, IgAN interventions generated 7864 QALYs (monetized benefit US$1.2 billion) and reduced waitlist size by 2138 candidates within 5 years. Finally, 1.77 QALYs were generated per treated patient with IgAN, 23% of which were attributable to spillover benefit.
CONCLUSIONS: IgAN interventions may provide health benefits beyond the direct clinical benefits to affected patients. These additional societal benefits should be considered when conducting value assessment of novel IgAN treatments.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE250
Topic
Economic Evaluation
Topic Subcategory
Novel & Social Elements of Value
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Urinary/Kidney Disorders, STA: Multiple/Other Specialized Treatments