Cost-utility analysis of simultaneous initiation of finerenone and empagliflozin for type 2 diabetes mellitus complicated with chronic kidney disease
Abstract
Background: Type 2 diabetes mellitus complicated with chronic kidney disease (T2DM-CKD) is a common and severe complication of T2DM that predisposes patients to end-stage renal disease (ESRD), substantially increasing mortality risk and long-term medical economic burden. Currently, SGLT-2 inhibitors are used as the foundational treatment regimen in clinical practice. As validated by the global multicenter randomized controlled CONFIDENCE trial, simultaneous initiation of finerenone plus an SGLT-2 inhibitor can further enhance renal protection and delay kidney disease progression. Despite these advancements, long-term pharmacoeconomic data supporting this combination regimen in the Chinese population remain limited.
Objective: From the perspective of China's healthcare system, this study aimed to evaluate the cost-utility of the simultaneous initiation of finerenone and empagliflozin versus empagliflozin monotherapy in T2DM-CKD patients, based on the CONFIDENCE trial design.
Methods: A Markov model was constructed to simulate the natural history of T2DM-CKD. The model cycle was 1 year, with a simulation time horizon of 30 years. The willingness-to-pay (WTP) threshold was set at three times China's 2025 per capita GDP (¥299,100/QALY). Base-case analysis was performed, followed by one-way and probabilistic sensitivity analyses to assess the robustness of results.
Results: Base-case analysis revealed that the incremental cost-effectiveness ratio (ICER, a measure comparing the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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