Short-term costs in patients with chronic kidney disease treated with dapagliflozin: a retrospective cohort study

ABSTRACT

Objectives

This real-world study evaluated the impact of dapagliflozin on short-term medical costs in patients with stage 3 chronic kidney disease (CKD).

Methods

This retrospective, observational cohort study used medical and pharmacy claims data from IQVIA PharMetrics Plus. Patients aged ≥18 years with a filled dapagliflozin prescription after stage 3 CKD diagnosis between September 2020 and December 2021 were 1:1 propensity score matched with patients with stage 3 CKD who did not receive dapagliflozin. The primary endpoint was cardiorenal medical costs to payers over 6 months; all-cause medical and pharmacy costs were also analyzed. Within the overall population, there was a new-user subgroup of patients with no sodium-glucose co-transporter-2 use during baseline.

Results

The new-user subgroup included 503 matched patients per cohort. Mean per-patient cardiorenal medical costs were reduced by 49.0% in the dapagliflozin versus non-dapagliflozin cohort ($3172.15 vs $6219.50; P < 0.001). Mean all-cause medical costs were reduced ($8043.58 vs $12,194.87; P < 0.001) and mean all-cause pharmacy costs were increased ($9056.98 vs $7453.23; P = 0.22). Results were similar for the overall population.

Conclusion

This study showed dapagliflozin was associated with reduced cardiorenal medical costs over 6 months compared with no dapagliflozin treatment in patients with stage 3 CKD, demonstrating real-world medical cost savings.

Plain Language Summary

Chronic kidney disease (CKD) is a condition in which the kidneys become progressively less effective at filtering blood. Patients with CKD also have an increased risk of cardiovascular disease, high blood pressure, and stroke. Dapagliflozin is a drug that can be prescribed for adults with CKD to reduce the risk of CKD worsening, hospitalization for heart failure, and death from cardiovascular disease. Because the cost of medications could affect whether they are prescribed to patients who could benefit from them, our goal was to study the impact of dapagliflozin treatment on short-term costs for patients in the United States with CKD. We used health insurance claims data to compare medical costs (sum of costs for treatment during hospital admissions and outpatient and emergency department visits) and pharmacy costs over 6 months between patients with stage 3 CKD treated with dapagliflozin with those for a matching group of patients who were not treated with dapagliflozin. The dapagliflozin group had a lower average medical cost for cardiorenal causes (related to CKD, including hospitalization for heart failure) paid by health insurance than the non-dapagliflozin group; the average cardiorenal medical cost patients paid themselves (out-of-pocket) was also lower for the dapagliflozin group. The average medical cost for all causes paid by insurance was also lower for the dapagliflozin group; this reduction was larger than the increase in the average all-cause pharmacy cost in the dapagliflozin group. Our study showed that treatment with dapagliflozin can lead to medical cost savings for patients with CKD.

KEYWORDS:

• Chronic kidney disease
• cost
• dapagliflozin
• healthcare resource utilization
• real-world evidence

Declaration of interest

J Dwyer has acted as a scientific consultant for AstraZeneca and has received fees from AstraZeneca for the conduct of this study; has received fees from Sanofi and CSL Behring as part of a steering committee; has received fees from Novo Nordisk for outcome adjudication for a trial; has received fees from Boehringer-Ingelheim and Lilly for study design; and received personal fees from Bayer. A Agiro and P Desai are employees and stockholders of AstraZeneca. H Cremisi was an employee and stockholder of AstraZeneca at the time of the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Study concept and design: J Dwyer, A Agiro, P Desai, H Cremisi. Data analysis: A Agiro. Data interpretation: J Dwyer, A Agiro, P Desai, H Cremisi. Drafting of the manuscript and/or revising it for critical intellectual content: J Dwyer, A Agiro, P Desai, H Cremisi. Final approval of the manuscript version to be published: J Dwyer, A Agiro, P Desai, H Cremisi. All authors agree to be accountable for all aspects of the work. All authors read and approved the final version of the manuscript to be published.

Acknowledgments

Daniel R. Turkewitz, PhD, and Raewyn M. Poole, MSc, of inScience Communications, Springer Healthcare, provided medical writing support in accordance with Good Publication Practice, funded by AstraZeneca. The authors wish to thank Joanna Huang and Richard Kraft, of AstraZeneca (Wilmington, Delaware, United States) for their contributions to the study concept and design.

Ethical conduct of research

This study used de-identified data and was therefore considered exempt from institutional review board approval as per Title 45 Code of Federal Regulations, part 46, specifically 45 CFR 46.101(b) (4).

Data availability statement

This was a claims database analysis using IQVIA PharMetrics Plus closed claims data obtained under license from IQVIA Inc. The raw data cannot be publicly shared since it was obtained from IQVIA and as per signed agreement between AstraZeneca and IQVIA Inc. However, we have provided all relevant data in the manuscript that supports the research objectives and conclusions. We confirm that interested researchers can reach out to IQVIA Inc. to access the data. For further information on data access, please contact IQVIA.

Prior presentation

Jamie P. Dwyer, Abiy Agiro, Pooja Desai, and Henry Cremisi. Short-term cost impact of dapagliflozin in chronic kidney disease. Poster presentation at the National Kidney Foundation (NKF) 2023 Spring Clinical Meeting, April 11–15, Austin, TX.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2237679.

Additional information

Funding

The study and development of the manuscript were funded by AstraZeneca.