ESTIMATING THE COST-EFFECTIVENESS OF SPARSENTAN RELATIVE TO REAL-WORLD RENIN-ANGIOTENSIN SYSTEMINHIBITION STANDARD OF CARE FOR IMMUNOGLOBULIN A NEPHROPATHY: A PATIENT-LEVEL MICROSIMULATION
Author(s)
Elmar R. Alizadeh, PhD1, Ryan Rava, PhD1, Devin Incerti, PhD1, Alison R. Ruderian, MPH1, Mark E. Bensink, MEd, MSc, PhD2;
1EntityRisk, Inc., Princeton, NJ, USA, 2Benofit Consulting, Brisbane, Australia
1EntityRisk, Inc., Princeton, NJ, USA, 2Benofit Consulting, Brisbane, Australia
OBJECTIVES: Immunoglobulin A Nephropathy (IgAN) is a rare chronic kidney disorder characterized by progressive loss of kidney function. Sparsentan is a dual endothelin angiotensin receptor antagonist (DEARA) shown to result in significant reductions in proteinuria and preservation of kidney function in adult patients with IgAN. This analysis evaluated the cost-effectiveness of sparsentan for IgAN relative to real-world renin-angiotensin system inhibition (RASi) standard of care (SoC).
METHODS: A patient-level microsimulation was parametrized using sparsentan Phase 3 PROTECT clinical trial data. The base case had a 60-year horizon, societal perspective, and 3% discount rate. Patients transitioned across nine mutually exclusive health states (CKD1-4, Kidney Failure without and with Dialysis, Post-kidney transplant, IgAN recurrence, and Death). At model start, urinary proteinuria excretion rate (UPER) and estimated glomerular filtration rate (eGFR) were jointly sampled via bootstrapping. Post-treatment % reduction in UPER was sampled via bootstrapping and applied to the baseline UPER after the first model cycle. UPER was utilized to assign an eGFR slope for each patient based on a real-world analysis. eGFR was then calculated at each model cycle, and a corresponding health state assigned. Digitized curves, where applicable, and estimates from literature informed all other state transitions and model parameters. Costs included treatment acquisition, clinical events, adverse events, health state, and indirect (i.e., labor and caregiver costs, time seeking care, and non-medical consumption). The model utilized generalized cost-effectiveness analysis, with stacked cohorts and dynamic pricing for sparsentan acquisition. Total costs and quality-adjusted life-years (QALYs) were estimated for each comparator, and the incremental cost-effectiveness ratio (ICER) of sparsentan relative to real-world RASi SoC was calculated.
RESULTS: Sparsentan dominates real-world RASi SoC with lifetime cost savings and QALYs gains of $14,812 and 0.25, respectively, yielding an ICER of -$58,183.
CONCLUSIONS: Sparsentan dominates real-world RASi SoC and is a valuable option for treating adult patients with IgAN.
METHODS: A patient-level microsimulation was parametrized using sparsentan Phase 3 PROTECT clinical trial data. The base case had a 60-year horizon, societal perspective, and 3% discount rate. Patients transitioned across nine mutually exclusive health states (CKD1-4, Kidney Failure without and with Dialysis, Post-kidney transplant, IgAN recurrence, and Death). At model start, urinary proteinuria excretion rate (UPER) and estimated glomerular filtration rate (eGFR) were jointly sampled via bootstrapping. Post-treatment % reduction in UPER was sampled via bootstrapping and applied to the baseline UPER after the first model cycle. UPER was utilized to assign an eGFR slope for each patient based on a real-world analysis. eGFR was then calculated at each model cycle, and a corresponding health state assigned. Digitized curves, where applicable, and estimates from literature informed all other state transitions and model parameters. Costs included treatment acquisition, clinical events, adverse events, health state, and indirect (i.e., labor and caregiver costs, time seeking care, and non-medical consumption). The model utilized generalized cost-effectiveness analysis, with stacked cohorts and dynamic pricing for sparsentan acquisition. Total costs and quality-adjusted life-years (QALYs) were estimated for each comparator, and the incremental cost-effectiveness ratio (ICER) of sparsentan relative to real-world RASi SoC was calculated.
RESULTS: Sparsentan dominates real-world RASi SoC with lifetime cost savings and QALYs gains of $14,812 and 0.25, respectively, yielding an ICER of -$58,183.
CONCLUSIONS: Sparsentan dominates real-world RASi SoC and is a valuable option for treating adult patients with IgAN.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE405
Topic
Economic Evaluation
Topic Subcategory
Novel & Social Elements of Value, Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Rare & Orphan Diseases, SDC: Urinary/Kidney Disorders, STA: Personalized & Precision Medicine