OBJECTIVES: Adding finerenone to current standard-of-care (SoC), including first-line ACEi/ARB and other therapies as recommended by Chinese guidelines, has shown substantial benefit in delaying chronic kidney disease (CKD) progression and reducing cardiovascular risk in patients with CKD and type 2 diabetes (T2D) in the landmark FIDELIO-DKD trial. This study aimed to evaluate the cost-effectiveness of finerenone+SoC versus SoC alone among patients with T2D and CKD in China from a healthcare system perspective.

METHODS: A cost-effectiveness model (FINE-CKD model) has been previously published, with health states defined according to stages of CKD progression (CKD 1/2, CKD 3, CKD 4, and CKD 5 without renal replacement therapy (RRT), dialysis or transplant) and history of cardiovascular events. The model differentiated between first and subsequent modelled cardiovascular events and adverse events. Transition probabilities and event risks were derived using patient-level data of the Asian population from the FIDELIO-DKD trial. Healthcare costs, expressed in 2023 Chinese Yuan (CNY), were gathered from literature and supplemented by physician interviews. EQ-5D-5L utility scores were estimated using data from the FIDELIO-DKD trial with China EQ-5D-5L value set. The annual discount rate was 5%. Sensitivity analyses were performed.

RESULTS: With a lifetime horizon, finerenone+SoC increased life years by 0.337 and quality-adjusted life years (QALYs) by 0.321 versus SoC alone (10.115 vs. 9.778 years, 8.660 vs. 8.338 QALYs), due to reduction in the incidence of cardiovascular events and dialysis. Total costs per patient were lower under finerenone+SoC than SoC alone (381,130 CNY vs. 392,390 CNY), demonstrating finerenone+SoC to be a dominant treatment strategy. Sensitivity analyses showed that finerenone+SoC would remain dominant, provided that the unit price of finerenone 10mg was less than or equal to 11.64 CNY.

CONCLUSIONS: This study suggested that adding finerenone to SoC was likely to be a dominant or cost-effective treatment strategy for patients with CKD and T2D in China.