The cost-effectiveness of second line diabetes medication added to standard therapy in preventing type 2 diabetes related nephropathy in Germany
Abstract
Background: Type 2 diabetes and its associated complications like nephropathy impose a serious burden on health systems. Several blood glucose-lowering medications have shown to be likely to provide nephroprotective properties, delaying or preventing the onset of kidney damage. Kidney-specific health-economic evaluations, comparing different agents, remain rare for Germany.
Methods: A Markov-microsimulation model was developed to obtain the perspective of the German statutory health system regarding cost-effectiveness. The model consists of five health states representing varying degrees of kidney damage with transition probabilities, utilities and costs being taken from published literature. Patient age was set to 62.8 years in the primary cohort; an additional analysis scenario was created with a start age of 50 years. The model outcomes life expectancy, quality adjusted life years, costs and net monetary benefit were discounted at 3% at a willingness-to-pay threshold of 100,000€ per quality adjusted life year gained.
Results: Quality adjusted life years increased from 10.28 years in standard care to 10.48 years with Empagliflozin, 10.58 years with Semaglutide and 10.75 years with Tirzepatide all added on top of standard care. Life expectancy increased from 13.36 years in the base case to 13.66 years, 13.76 years and 14.00 years with Empagliflozin, Semaglutide and Tirzepatide respectively. Total direct cost amounted to 66,343.64€ in the base case, 79,767.42€ with…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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