A Cost-Utility Analysis of Sparsentan for the Treatment of Immunoglobulin A Nephropathy in the UK
Author(s)
Antonio Ramirez de Arellano Serna, MSc, DPhil1, Garth Baxter, BSc2, Tom Edmonds, BSc3.
1Director HEOR, CSL Vifor, Glattbrugg, Switzerland, 2CSL Vifor, Maidenhead, United Kingdom, 3Initiate Consultancy, Nottingham, United Kingdom.
1Director HEOR, CSL Vifor, Glattbrugg, Switzerland, 2CSL Vifor, Maidenhead, United Kingdom, 3Initiate Consultancy, Nottingham, United Kingdom.
OBJECTIVES: Immunoglobulin A nephropathy (IgAN) is a rare disorder associated with reduced kidney function and increased risk of end-stage renal disease (ESRD) that imposes a significant burden on both patients and payers. This study evaluated the cost-effectiveness of sparsentan compared with maximally tolerated dose of irbesartan for the treatment of adults with IgAN from an NHS perspective.
METHODS: A lifetime Markov state-transition model was developed to simulate disease progression in patients treated with sparsentan compared with standard of care (SoC). The model includes 16 health states, with 12 defined by CKD stage and urine protein to creatine ratio (UP/C), 3 describing ESRD (pre-renal-replacement therapy, dialysis, and transplant), and death. The modelled population was aligned with the indication for sparsentan (primary IgAN with proteinuria ≥1.0 g/day or UP/C ≥0.75 g/g). Health state transitions were informed by PROTECT trial data, UK real-world evidence from the RaDaR database, and the UK Renal Registry. Only direct costs and benefits were considered and discounted at 3.5% per annum. Model sensitivity was assessed through deterministic and probabilistic sensitivity analysis.
RESULTS: Sparsentan was estimated to delay progression to ESRD in patients with IgAN, resulting in 0.81 - 0.83 additional QALYs. Although sparsentan was associated with higher drug acquisition costs, these were partially offset by reductions in disease management costs, particularly for ESRD, resulting incremental costs of £15,280 - £27,130. Cost-effectiveness was robust to deterministic and probabilistic sensitivity analyses, with the incremental cost effectiveness ratio falling between £18,420 - £33,310/QALY with varying CKD transition scenarios.
CONCLUSIONS: Sparsentan may ameliorate the burden imposed by IgAN on patients, with significant offsets to treatment cost that could positively impact service provision in the NHS. Sparsentan represents a cost-effective option for IgAN patients in the NHS at conventional willingness-to-pay thresholds, offering improved patient outcomes by delaying CKD progression and initiation of renal-replacement therapy.
METHODS: A lifetime Markov state-transition model was developed to simulate disease progression in patients treated with sparsentan compared with standard of care (SoC). The model includes 16 health states, with 12 defined by CKD stage and urine protein to creatine ratio (UP/C), 3 describing ESRD (pre-renal-replacement therapy, dialysis, and transplant), and death. The modelled population was aligned with the indication for sparsentan (primary IgAN with proteinuria ≥1.0 g/day or UP/C ≥0.75 g/g). Health state transitions were informed by PROTECT trial data, UK real-world evidence from the RaDaR database, and the UK Renal Registry. Only direct costs and benefits were considered and discounted at 3.5% per annum. Model sensitivity was assessed through deterministic and probabilistic sensitivity analysis.
RESULTS: Sparsentan was estimated to delay progression to ESRD in patients with IgAN, resulting in 0.81 - 0.83 additional QALYs. Although sparsentan was associated with higher drug acquisition costs, these were partially offset by reductions in disease management costs, particularly for ESRD, resulting incremental costs of £15,280 - £27,130. Cost-effectiveness was robust to deterministic and probabilistic sensitivity analyses, with the incremental cost effectiveness ratio falling between £18,420 - £33,310/QALY with varying CKD transition scenarios.
CONCLUSIONS: Sparsentan may ameliorate the burden imposed by IgAN on patients, with significant offsets to treatment cost that could positively impact service provision in the NHS. Sparsentan represents a cost-effective option for IgAN patients in the NHS at conventional willingness-to-pay thresholds, offering improved patient outcomes by delaying CKD progression and initiation of renal-replacement therapy.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE17
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Rare & Orphan Diseases, Urinary/Kidney Disorders