COST-EFFECTIVENESS OF TOLVAPTAN IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE: A STUDY FROM A JORDANIAN PUBLIC PAYER PERSPECTIVE
Author(s)
Rawan Alfroukh, Master Degree, Health Economic & pharmacoeconomics1, Suha Al Omar, Doctor of pharmacy1, Farah Radaideh, Master Degree, Health policy planning and financin1, Khader Al-Habash, Sr., PharmD2, Duaa AlBararari, Master of Business Administration (M.B.A.), Market3, Nimer Alkhatib, PhD1.
1Path Economics,LLC, Amman, Jordan, 2Market Access, Hikma Pharmaceuticals, Amman, Jordan, 3Market Access, hikma Pharmaceuticals, Amman, Jordan.
1Path Economics,LLC, Amman, Jordan, 2Market Access, Hikma Pharmaceuticals, Amman, Jordan, 3Market Access, hikma Pharmaceuticals, Amman, Jordan.
OBJECTIVES: To assess the cost-effectiveness of tolvaptan plus standard therapy compared with standard therapy alone for adults with rapidly progressing autosomal dominant polycystic kidney disease (ADPKD) from the Jordanian public payer perspective.
METHODS: A cost-effectiveness analysis using a decision-tree followed by a Markov model adapted to the Jordanian public health jurisdiction. The model simulated ADPKD patients starting at age 40 years, with baseline estimated glomerular filtration rate of 80 mL/min/1.73 m², over a 40-year horizon with annual cycles. Mortality incorporated Jordan-specific life-table data and End Stage Renal Disease (ESRD) mortality based on the Jordanian national registry. Clinical inputs were informed by TEMPO3:4 trial and a published economic model. The primary outcome was the mean patients’ age at the onset of ESRD, secondary outcomes were the incremental cost-effectiveness ratio (ICER) per one-year delay in ESRD onset, per life-year gained, and per quality-adjusted life-year (QALY). A 3% annual discount rate was applied to both costs and outcomes. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) assessed uncertainty.
RESULTS: Tolvaptan delayed ESRD onset by 7 years compared with no treatment, the mean age at ESRD onset increased from 58 years with no treatment to 65 years with tolvaptan. Discounted lifetime costs were JOD 102,493 with standard care and JOD 126,460 with tolvaptan, The ICER was JOD 3,424 per one-year delay in ESRD, JOD 11,464 per life-year gained, and JOD 12,034 per QALY gained. DSA results showed that the ICER was mainly driven by tolvaptan annual acquisition cost, the annual discontinuation rate, ESRD annual cost, and liver-function-test monitoring cost. PSA results were similar to the base-case results.
CONCLUSIONS: Tolvaptan delayed ESRD onset, increased life-years and QALYs in ADPKD patients compared to no treatment. From the Jordanian public payer perspective, tolvaptan represents a cost-effective option at a willingness-to-pay threshold of three-times gross domestic product per capita.
METHODS: A cost-effectiveness analysis using a decision-tree followed by a Markov model adapted to the Jordanian public health jurisdiction. The model simulated ADPKD patients starting at age 40 years, with baseline estimated glomerular filtration rate of 80 mL/min/1.73 m², over a 40-year horizon with annual cycles. Mortality incorporated Jordan-specific life-table data and End Stage Renal Disease (ESRD) mortality based on the Jordanian national registry. Clinical inputs were informed by TEMPO3:4 trial and a published economic model. The primary outcome was the mean patients’ age at the onset of ESRD, secondary outcomes were the incremental cost-effectiveness ratio (ICER) per one-year delay in ESRD onset, per life-year gained, and per quality-adjusted life-year (QALY). A 3% annual discount rate was applied to both costs and outcomes. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) assessed uncertainty.
RESULTS: Tolvaptan delayed ESRD onset by 7 years compared with no treatment, the mean age at ESRD onset increased from 58 years with no treatment to 65 years with tolvaptan. Discounted lifetime costs were JOD 102,493 with standard care and JOD 126,460 with tolvaptan, The ICER was JOD 3,424 per one-year delay in ESRD, JOD 11,464 per life-year gained, and JOD 12,034 per QALY gained. DSA results showed that the ICER was mainly driven by tolvaptan annual acquisition cost, the annual discontinuation rate, ESRD annual cost, and liver-function-test monitoring cost. PSA results were similar to the base-case results.
CONCLUSIONS: Tolvaptan delayed ESRD onset, increased life-years and QALYs in ADPKD patients compared to no treatment. From the Jordanian public payer perspective, tolvaptan represents a cost-effective option at a willingness-to-pay threshold of three-times gross domestic product per capita.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE743
Topic
Economic Evaluation
Disease
Urinary/Kidney Disorders