Time to Invest in the Future: Assessing the Cost-Effectiveness of Empagliflozin in Diabetic Kidney Disease
Abstract
glycemic control in conjunction with managing hypertension with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers. Recently, multiple randomized controlled trials have unequivocally demonstrated the cardiovascular and renoprotective benefits of SGLT2 inhibitors, revolutionizing the management of diabetes and DKD (Table 1). But these drugs are not cheap: the wholesale cost of empagliflozin is $530 per month. The elephant in the room is whether the benefits of SGLT2 inhibitors sufficiently offset the outsized costs of kidney replacement therapy (KRT) to justify their expensive price tag. In this issue of AJKD, Reifsnider et al sought to answer this question. They did so with a cost-effectiveness analysis, by weighing the costs and benefits of empagliflozin over standard of care without an SGLT inhibitor. The main measure of interest is the incremental cost-effectiveness ratio (ICER), or the increase in costs from adding empagliflozin to DKD treatment divided by the gains in qualityadjusted life-years (QALYs). Simply put, the ICER is the price of 1 additional QALY, or 1 additional year of perfect health. Cost-effectiveness analyses typically use QALYs to account for differences in health: an additional year of poor health is clearly different from an additional year of perfect health. At what ICER is a treatment considered good value? While there is no consensus, experts generally use thresholds of less than $50,000/QALY up to $150,000/QALY for…
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Evidence Hub reads this as a randomized trial, done in people. 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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