OBJECTIVES Based on the renal and cardiovascular benefits demonstrated in the CREDENCE trial, canagliflozin has received a licence extension for the treatment of DKD in Europe. As canagliflozin is the first treatment for DKD in nearly two decades, a new micro-simulation model was developed to estimate the cost effectiveness of canagliflozin added to standard of care (SoC) versus SoC alone. We present results of a cost utility analysis (CUA) for England, conducted in accordance with NICE methods.

METHODS The model was built with patient-level data from CREDENCE and includes risk equations for start of dialysis, hospitalisation for heart failure (HHF), non-fatal myocardial infarction (MI), non-fatal stroke, and all-cause mortality. Progression of DKD is modelled using evolution equations for estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (UACR), with patients transitioned to dialysis at an eGFR of 6ml/min/1.73m² as a fail-safe. The model was loaded with baseline characteristics and treatment effects from CREDENCE. Unit costs and disutility weights were sourced from the literature with costs inflated to £2019. The base case time horizon was 40 years and 500 cohorts of 500 hypothetical patients were simulated. Sensitivity analyses were performed. Costs and QALYs were discounted at 3.5% annually.

RESULTS Canagliflozin plus SoC was associated with gains in life-years and QALYs versus SoC of 2.47 and 1.95 respectively over 40 years, driven largely by reductions in the rates of dialysis start (60%) and HHF (29%), MI (16%), and stroke (17%) events. Substantial cost offsets for dialysis (£12651) and transplant (£8871) lead to cost savings for canagliflozin (£8897 per patient).

CONCLUSIONS Extrapolating the CREDENCE trial over 40 years suggests that canagliflozin can substantially reduce rates of renal and cardiovascular outcomes, increase longevity, and save costs in this high unmet need population.