COST-UTILITY ANALYSIS OF SPARSENTAN FOR THE TREATMENT OF IMMUNOGLOBULIN A NEPHROPATHY: A COMPARISON OF SPARSENTAN VERSUS IRBESARTAN AND MODIFIED-RELEASE BUDESONIDE IN SPAIN
Author(s)
Marian Goicoechea, Dr1, Eduardo Parra, Dr2, Mónica Climente Martí, PhD3, Antonio Ramirez de Arellano Serna, MSc, DPhil4, OLGA RUIZ ANDRES, PhD, MBA5, Clarissa Sancho, MSc6, Noemi Lopez, MSc6, Elisenda Pomares, MSc6, Tom Edmonds, MSc7.
1Hospital General Universitario Gregorio Marañón, Madrid, Spain, 2Hospital Universitario Miguel Servet, Zaragoza, Spain, 3Hospital Universitario Dr. Peset, Valencia, Spain, 4CSL, Zürich, Switzerland, 5CSL, Barcelona, Spain, 6Cencora PharmaLex, Barcelona, Spain, 7Initiate Consultancy, Nottingham, United Kingdom.
1Hospital General Universitario Gregorio Marañón, Madrid, Spain, 2Hospital Universitario Miguel Servet, Zaragoza, Spain, 3Hospital Universitario Dr. Peset, Valencia, Spain, 4CSL, Zürich, Switzerland, 5CSL, Barcelona, Spain, 6Cencora PharmaLex, Barcelona, Spain, 7Initiate Consultancy, Nottingham, United Kingdom.
OBJECTIVES: Immunoglobulin A nephropathy (IgAN) is a rare kidney disease that may progress to end‑stage renal disease (ESRD). Sparsentan, a dual endothelin and angiotensin receptor antagonist indicated for adults with primary IgAN and urine protein excretion (UPE) ≥1.0 g/day (or urine protein-to-creatinine ratio [UPCR] ≥0.75 g/g), was assessed to evaluate its cost‑effectiveness in Spain.
METHODS: A cohort-level Markov state-transition model simulated disease progression over a 54-year time horizon. Two comparison scenarios were defined, with irbesartan and modified‑release budesonide as therapeutic alternatives. Sixteen health states were considered: four UPE categories (<0.5, 0.5-1.0, 1.0-2.0, >2.0 g/day), each divided in three chronic kidney disease (CKD) stages (G1/2, G3, G4), three CKD G5 stages (pre-renal replacement therapy, dialysis and transplant), and death. Comparative efficacy of the change from baseline UPE was informed by PROTECT (irbesartan scenario) and from a matching‑adjusted indirect comparison of PROTECT versus NefIgArd trials (modified‑release budesonide scenario). CKD progression was based on evidence from the PROTECT trial and the United Kingdom National Registry of Rare Kidney Diseases. ESRD transitions relied on Spanish Renal Registry data, complemented by expert input and market research. Direct costs (payer perspective; 2025/EUR) comprised drug acquisition, disease management, ESRD care and adverse events management. Quality-adjusted life years (QALYs) captured health effects. Model robustness was assessed through sensitivity analyses.
RESULTS: Sparsentan showed greater QALYs compared with both irbesartan (14.64 versus 12.87) and modified‑release budesonide (15.45 versus 13.70). In the base case, sparsentan was considered cost‑effective at a willingness‑to‑pay threshold of €60,000/QALYs versus irbesartan and of €25,000/QALYs versus modified‑release budesonide. Cost offsets associated with sparsentan were primarily driven by reductions in ESRD management costs. Sensitivity analyses supported the robustness of the base‑case findings.
CONCLUSIONS: Sparsentan is a cost-effective treatment in Spain, improving QALYs by slowing CKD progression and reducing ESRD risk, with additional treatment costs partially offset by reduced ESRD management costs.
METHODS: A cohort-level Markov state-transition model simulated disease progression over a 54-year time horizon. Two comparison scenarios were defined, with irbesartan and modified‑release budesonide as therapeutic alternatives. Sixteen health states were considered: four UPE categories (<0.5, 0.5-1.0, 1.0-2.0, >2.0 g/day), each divided in three chronic kidney disease (CKD) stages (G1/2, G3, G4), three CKD G5 stages (pre-renal replacement therapy, dialysis and transplant), and death. Comparative efficacy of the change from baseline UPE was informed by PROTECT (irbesartan scenario) and from a matching‑adjusted indirect comparison of PROTECT versus NefIgArd trials (modified‑release budesonide scenario). CKD progression was based on evidence from the PROTECT trial and the United Kingdom National Registry of Rare Kidney Diseases. ESRD transitions relied on Spanish Renal Registry data, complemented by expert input and market research. Direct costs (payer perspective; 2025/EUR) comprised drug acquisition, disease management, ESRD care and adverse events management. Quality-adjusted life years (QALYs) captured health effects. Model robustness was assessed through sensitivity analyses.
RESULTS: Sparsentan showed greater QALYs compared with both irbesartan (14.64 versus 12.87) and modified‑release budesonide (15.45 versus 13.70). In the base case, sparsentan was considered cost‑effective at a willingness‑to‑pay threshold of €60,000/QALYs versus irbesartan and of €25,000/QALYs versus modified‑release budesonide. Cost offsets associated with sparsentan were primarily driven by reductions in ESRD management costs. Sensitivity analyses supported the robustness of the base‑case findings.
CONCLUSIONS: Sparsentan is a cost-effective treatment in Spain, improving QALYs by slowing CKD progression and reducing ESRD risk, with additional treatment costs partially offset by reduced ESRD management costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE406
Topic
Economic Evaluation
Disease
Rare & Orphan Diseases, Urinary/Kidney Disorders