OBJECTIVES: Based on renal and cardiovascular benefits demonstrated in the CREDENCE trial, canagliflozin (CANA) received a novel indication to reduce the risk of end-stage kidney disease (ESKD), doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure (HHF) in patients T2D and DKD with albuminuria >300 mg/day. As CANA is the first new pharmacotherapy for this population in nearly two decades, economic stakeholders are unfamiliar with assessing the cost offsets associated with treatment. The purpose of this study was to use an economic microsimulation model to estimate health outcomes and cost offsets associated with CANA versus standard of care (SOC) in this patient population from a US payer perspective.

METHODS: The economic model, CREDEM-DKD, was built with patient-level data from CREDENCE and includes risk equations for the following events: HHF, start of dialysis, non-fatal myocardial infarction (MI), non-fatal stroke, and all-cause mortality. Equations for estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (UACR) evolution were used to capture DKD progression. The model was loaded with baseline characteristics and treatment effects from CREDENCE. Unit costs were sourced from literature and inflated to $2018. In the base case, health trajectories were simulated over 5 years for 1,000 cohorts of 1,000 hypothetical patients. Sensitivity analyses were performed.

RESULTS: In the base case, treatment with CANA versus SOC was associated with 20% fewer dialysis starts; 36%, 16%, and 18% fewer HHF, MI, and stroke events, respectively; and 0.08 life-years gained. The largest estimated 5-year cost-offsets were for dialysis and HHF at about $4,000 and $1,000 per patient, respectively, increasing to approximately $7,700 and $1,500, respectively, in the 10-year simulation.

CONCLUSIONS: Results of these simulations suggest that for this high unmet need patient population, treatment with CANA will result in fewer renal, cardiovascular, and mortality events and sizable cost offsets.