OBJECTIVES: The recent EMPA-KIDNEY trial showed evidence for a new indication of empagliflozin for treating adult patients for chronic kidney disease (CKD). It is however unknown if this is cost-effective. We aimed to evaluate the cost-effectiveness of empagliflozin in adult patients with CKD in the Netherlands.

METHODS: A cost-effectiveness analysis was conducted using a Markov state microsimulation model simulating the kidney progression of CKD patients with eGFR <90 ml/min per 1.73 m2. KDIGO classification was used to describe the CKD prognosis. The input data were taken from the EMPA-KIDNEY trial (baseline characteristics and effectiveness), published data and national (Dutch) sources for mortality, treatment- and event costs, and utilities. The analyses were preformed from a healthcare system perspective with a lifetime horizon. The comparison was made between empagliflozin plus standard of care (SoC) and SoC alone. The incremental cost-effectiveness ratio was compared to a willingness-to-pay threshold of €50,000/QALY. Sensitivity analyses were performed to explore the uncertainties around the input parameters.

RESULTS: The base case results, using a time horizon (maximum 100 years), showed total discounted costs for empagliflozin plus SoC, and SoC alone of €275,400 and €399,602 respectively, with savings of €124,202. Empagliflozin plus SoC was associated with higher total discounted health benefits of 10.99 LYs and 7.94 QALYs, compared with 9.65 LYs and 6.81 QALYs for SoC alone, or an additional 1.33 LYs and additional 1.14 QALYs for empagliflozin plus SoC. As a result, empagliflozin plus SoC can be considered a dominant alternative compared to SoC alone. Sensitivity analyses confirmed the robustness of the findings and conclusion.

CONCLUSIONS: Using empagliflozin in addition to SoC in adult CKD patients is likely to be cost-saving compared to the current SoC in the Netherlands.