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The prevalence of chronic kidney disease (CKD) in Brunei is reported to be 12.2%. At stage 3 and later, CKD is associated with mortality rates that are 3–13 times higher than the general population, along with significant comorbidities and increases in healthcare costs. Consequently, there may be significant healthcare and economic benefits to be gained from halting or delaying CKD progression. Dapagliflozin has been shown to delay CKD progression to kidney failure and cardiovascular (CV) or renal death in the Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial. Given high cardio-renal complications in this population, it would be useful for policy makers to understand the potential clinical & economic benefits of introducing dapagliflozin in CKD.
A medical care cost-offset model (COM) was developed to quantify short-term predicted clinical, and health economic outcomes associated with dapagliflozin treatment in CKD patients in Brunei. The model used a comparative cost determination framework to estimate the outcome-related costs of dapagliflozin plus standard of care (SoC) versus SoC alone. Seven CKD-related outcomes were included in the analysis (Table 1). DAPA-CKD event rates were used to predict the incidence of included outcomes over 3 years. Cost-offsets for Brunei was estimated through the application of country-specific event costs upon event incidence obtained from the Brunei healthcare system records. ESKD costs were calculated on a weighted aggregate of CKD stage 5, kidney transplantation, and dialysis based on distribution from the DAPA-CKD trial. Results were estimated in a treated CKD population of 54339 patients who were eligible for treatment with dapagliflozin on top of SOC based on their medical history and baseline characteristics.
1. Clinical End Points: 3942 additional incidences of primary composite endpoint were avoided in patients treated with dapagliflozin versus those treated with SoC alone (Table 1; Fig 1).
2. Health Economic Results: Treatment with dapagliflozin resulted in an incremental reduction in total direct costs of USD $81.76 million in CKD management cumulatively over a period of 3 years (Table 2). There was a USD $13.58 million incremental cost reduction in overall CKD management in 1st year of treatment which was further reduced by USD $28.37 million & USD $39.80 million in 2nd and 3rd year respectively. (Fig 2)
Dapagliflozin significantly reduced healthcare resource utilization in CKD patients through delayed CKD progression, reduced incidence of AKI & hHF, ameliorating the burden imposed by CKD on both patients and healthcare systems. This study projected that across 54,339 CKD patients treated with dapagliflozin + SoC vs SoC alone, there was an overall cost reduction of USD $81.76 million (18.9% reduction) in the management of CKD & associated complications over a 3-year period in Brunei.