OBJECTIVES: This study examines the impact of guideline updates on the cost-effectiveness of finerenone as an add-on to standard of care (SoC) in adults with chronic kidney disease (CKD) with type 2 diabetes (T2D). The analysis adopted a UK National Health Service and Personal Services perspective, with a lifetime horizon.

METHODS: The FINE-CKD model, a previously established Markov model incorporating clinical data from the FIDELIO-DKD trial, considers kidney disease progression and CV risk, with health states encompassing patients’ kidney disease stage and CV event profiles. A range of commonly prescribed therapies for patients with CKD and T2D are considered, including SGLT2 inhibitors. Following guideline updates, real-world data suggest SGLT2 inhibitors are used by 22% of these patients in the UK vs. 6.2% in the FIDELIO-DKD trial. The impact of these data on the cost-effectiveness of finerenone was investigated through an adjustment, using RCT data relating to SGLT2 inhibitors, of the baseline risk of CV events and CKD progression. Consistent with the literature, the relative benefits of finerenone use in combination with SGLT2 inhibitors were held constant.

RESULTS: Increasing the SGLT2 inhibitor usage in line with published real-world data, marginally decreased the improvement in quality-adjusted life years (QALYs) gained by adding finerenone to SoC, from 0.139 to 0.136 QALY per patient, decreased the incremental costs from £1488 to £1288, and increased the incremental cost-effectiveness ratio (ICER) from £8808 to £9490 per QALY gained. Deterministic and probabilistic sensitivity analyses corroborated these findings. In an unlikely scenario analysis considering SGLT2 inhibitor utilization of 100%, the ICER would remain below the UK cost-effectiveness threshold, at £14,212 per QALY gained.

CONCLUSIONS: Finerenone is a cost-effective treatment option when added to SoC for CKD in T2D, even with implementation of updated guidelines.