Empagliflozin Demonstrates Cost-Effectiveness in Chronic Kidney Disease Treatment, EMPA-KIDNEY Analysis Shows
Key Insights
A new analysis from the EMPA-KIDNEY trial demonstrates that empagliflozin is cost-effective for chronic kidney disease treatment, improving quality-adjusted life years while reducing healthcare costs.
The study found that empagliflozin reduced hospital admissions by 14% and generated net healthcare cost savings of approximately £600 per patient over four years.
Cost-effectiveness probability increased from 43% at two years to 91% at four years, with benefits consistent across patient subgroups including those with and without diabetes.
A comprehensive economic analysis of the landmark EMPA-KIDNEY trial has demonstrated that empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i), represents a cost-effective treatment option for people with chronic kidney disease (CKD). The study, published in eClinicalMedicine, provides crucial evidence supporting the widespread adoption of this therapy in CKD management.
The analysis examined data from EMPA-KIDNEY, the largest randomized controlled trial of SGLT2i treatment in CKD patients, involving over 6,600 participants across eight countries. The trial previously demonstrated that empagliflozin reduced the risk of kidney disease progression or cardiovascular death by 28% in people with CKD.
Healthcare Utilization and Cost Reduction
The economic evaluation revealed significant reductions in healthcare resource utilization among patients allocated to empagliflozin. Over the median follow-up period of 2.0 years, empagliflozin allocation resulted in fewer hospital admissions with a hazard ratio of 0.86 (95% confidence interval 0.78-0.95), representing a 14% reduction in hospitalization risk.
Additionally, patients receiving empagliflozin experienced fewer days on concomitant medications (rate ratio 0.98, 0.95-1.00) and lower costs associated with these medications (rate ratio 0.90, 0.85-0.96). While only a small number of participants initiated kidney replacement therapy, there was no statistically significant difference in these costs (rate ratio 0.74, 0.33-1.69).
Quality-Adjusted Life Years and Long-term Benefits
The analysis demonstrated that two years of empagliflozin treatment improved quality-adjusted life years (QALYs), with an additional 0.016 QALYs (0.001-0.032) per participant over 2.5 years. This improvement reflects more years of good health for patients allocated to receive empagliflozin compared to placebo.
Dr. Junwen Zhou, Senior Researcher at the Health Economics Research Centre and first author of the study, emphasized the significance of these findings: "Our findings show that empagliflozin improves quality-adjusted survival while also reducing the use and cost of other healthcare. This makes it a highly cost-effective treatment for people with chronic kidney disease."
Cost-Effectiveness Analysis
The economic evaluation revealed that empagliflozin's healthcare cost reductions offset approximately two-thirds of the drug's costs over 2.5 years, with an estimated net cost of healthcare use of £353 (8-698) per participant. Over the extended four-year analysis period, including post-trial follow-up, empagliflozin generated total net healthcare cost savings of approximately £600 per person.
The probability of cost-effectiveness showed marked improvement over time. While the probability stood at 43% at the £20,000/QALY threshold over two years, this increased substantially to 91% over four years due to ongoing cost savings from delayed progression to end-stage kidney disease (ESKD).
Consistent Benefits Across Patient Populations
The benefits of empagliflozin demonstrated consistency across different patient subgroups, including those with and without diabetes, and patients at varying levels of kidney function and albuminuria. The analysis showed that empagliflozin was associated with larger cost savings in patients at higher risk of kidney disease progression.
Dr. Borislava Mihaylova, Associate Professor at the Health Economics Research Centre and senior author of the study, noted: "The benefits seen with two years of empagliflozin treatment during the active-trial and post-trial follow-up periods suggest that even larger health benefits and cost savings are expected with long-term SGLT2i treatment, with potential for significant reductions in kidney failure risk and costs."
Clinical and Policy Implications
The findings provide strong support for current National Institute for Health and Care Excellence (NICE) recommendations for empagliflozin use in CKD management. Professor Will Herrington, co-chief investigator of EMPA-KIDNEY, commented: "Our results support current National Institute for Health and Care Excellence (NICE) recommendations for the use of empagliflozin in CKD management. We hope that these results will encourage more widespread prescription of SGLT2i to patients at risk of CKD progression."
The researchers acknowledge that the trial's relatively short active treatment period may underestimate the long-term cost-effectiveness of empagliflozin. Furthermore, with generic versions expected to reduce SGLT2 inhibitor costs significantly in the near future, even greater cost-effectiveness is anticipated.
Empagliflozin is currently recommended for CKD treatment in several countries, including Ecuador, Egypt, Peru, Saudi Arabia, Taiwan, the United Arab Emirates, United Kingdom, and the United States of America, as well as in the European Union. These economic findings provide timely evidence to support clinical guidelines and inform policy decisions around SGLT2 inhibitor use for people living with CKD.