Clinicians know the drug dapagliflozin helps patients with chronic kidney disease that stems from diabetes. New Stanford-led research now shows the drug is also a powerful, cost-effective treatment in those who suffer from CKD even if their disease is not caused by diabetes.
An estimated one-in-seven adults in the United States suffer from chronic kidney disease, with an annual $100 billion in health-care costs. The condition means kidneys don’t properly filter impurities from the blood, which can lead to a buildup of waste in the body and an increased risk of cardiovascular disease, impaired physical and cognitive function and overall reduced quality of life.
“Since a huge number of Americans have chronic kidney disease, this treatment could improve quality of life and longevity for many thousands of people, so finding that it is 'worth it' cost-wise is really important for justifying its use,” said SHP’s Rebecca L. Tisdale, MD, MPA, co-lead author of the study published in the Journal of General Internal Medicine. The other co-lead author is Marika Cusick, a PhD student at Stanford Health Policy.
"Clinicians may be hesitant to prescribe a new drug without research demonstrating that it produces reasonable benefits for the cost — and this finding can provide some of that reassurance," Tisdale said
Stanford Health Policy Director Douglas K. Owens, senior author of the study, said the team conducted a model-based cost-effectiveness analysis and found that dapagliflozin provides an important new tool for patients with chronic kidney disease, the ninth leading cause of death in the United States.
Tisdale, an internist and postdoctoral research fellow with Stanford Health Policy and the Palo Alto VA, explained that the researchers evaluated the cost-effectiveness of adding dapagliflozin to the existing standard care of treatment, one of two closely related classes of drugs, ACE inhibitors or ARBs.
The team found that adding dapagliflozin to standard care improved life expectancy by two years. The new treatment would increase lifetime costs by $60,000 per QALY (quality-adjusted life years), which is considered a reasonable additional price to pay for living longer and decreases in the need for kidney transplant and dialysis treatment.
While CKD affects about 12.5% of Medicare beneficiaries, it is responsible for a disproportionate 23% of expenditures even before accounting for enrollees with end-stage kidney disease.
“These numbers further illustrate the complexity of care for CKD, and we are delighted to have found a cost-effective treatment option,” said Cusick.
The other co-authors of the study are Kelly Zhang Aluri, Thomas J. Handley, Alice Kate Cummings Joyner, Joshua A. Salomon, Glenn M. Chertow, and Jeremy Goldhaber-Fiebert.