Objective: Chronic kidney disease (CKD) is a high-cost chronic disease with costly complications, like hemodialysis, peritoneal dialysis, and cardiovascular diseases (CVDs). This study evaluated dapagliflozin cost-utility in patients with CKD in Costa Rica.

Method: A Markov model was developed considering five states: CKD, end-stage renal disease (ESRD), CVDs, ESRD and CVDs simultaneously, and death. The base case is an adult with or without type 2 diabetes who had an estimated glomerular filtration rate of 25-75ml/minute per-1.73m2 of the body-surface area and a urinary albumin-to-creatinine ratio of 200-5000. Perspective is from the third payer; comparators are dapagliflozin or no treatment. Outcomes are ESRD, CVDs, ESRD and CVDs, and death and are expressed in Quality Adjusted Life Years (QALYs). There are three-time horizons, 12, 24, and 32 months, based on the efficacies of the pivotal clinical trial of dapagliflozin in HF. Willingness-to-Pay (WTP) used was three times the gross domestic product per capita (USD 36,230).

Results: At 12 months of follow-up, the dapagliflozin strategy costs $1,089 and generates 0.982 QALYs, and without treatment, the cost is $1,067 and generates 0.966 QALYs. At 24 months, the dapagliflozin strategy costs $2,490 and generates 1.90 QALYs, and without treatment, it is $2,376 and generates 1.85 QALYs. At 36 months, dapagliflozin strategy costs $3,893 and generates 1.90 QALYs, and without treatment, it is $3,486 and generates 1.85 QALYs. At 12 months, the Incremental Cost-Effectiveness Ratio is $1,337; at 24 months, $2,101; and at 32 months, $3,011 per additional QALY gained. Willingness-to-pay curves estimate that the probability that dapagliflozin is the best treatment strategy at 12 months is 93.6%, at 24 months, 93.5%, and at 32 months, 95.4%.

Conclusion: Dapagliflozin is a highly cost-effective strategy for treating CKD in Costa Rica. Patients with dapagliflozin have less life-threatening and costly complications than those who do not receive it.