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

Figures & data

Table 1. Baseline patient demographics, clinical characteristics, medications, and healthcare resource utilization after propensity score matching.

	Overall population			New-user subgroup^a
	Dapagliflozin matched (N = 783)	Non-dapagliflozin matched (N = 783)	SMD	Dapagliflozin matched (N = 503)	Non-dapagliflozin matched (N = 503)	SMD
Age at index, mean (SD)	63.8 (10.4)	65.2 (11.4)	0.14	64.3 (11.1)	66.5 (11.6)	0.19
Sex, n (%)			0.05			0.09
Female	278 (35.5)	297 (37.9)		173 (34.4)	194 (38.6)
Male	505 (64.5)	486 (62.1)		330 (65.6)	309 (61.4)
Insurance type, n (%)			0.06			0.10
Commercial	560 (71.5)	538 (68.7)		334 (66.4)	300 (59.6)
Medicare Advantage	223 (28.5)	245 (31.3)		169 (33.6)	203 (40.4)
Region, n (%)			0.09			0.07
Midwest	225 (28.7)	207 (26.4)		159 (31.6)	164 (32.6)
Northeast	93 (11.9)	115 (14.7)		67 (13.3)	68 (13.5)
South	347 (44.3)	336 (42.9)		202 (40.2)	185 (36.8)
West	118 (15.1)	125 (16.0)		75 (14.9)	86 (17.1)
Comorbidities during the 12-month baseline period, n (%)
Hypertension	740 (94.5)	751 (95.9)	0.06	481 (95.6)	485 (96.4)	0.04
Type 2 diabetes	679 (86.7)	679 (86.7)	0.00	401 (79.7)	401 (79.7)	0.00
Dyslipidemia	644 (82.2)	675 (86.2)	0.10	410 (81.5)	431 (85.7)	0.06
Coronary artery disease	280 (35.8)	271 (34.6)	0.02	206 (41.0)	190 (37.8)	0.03
Heart failure	262 (33.5)	262 (33.5)	0.00	217 (43.1)	217 (43.1)	0.00
Peripheral artery disease	143 (18.3)	168 (21.5)	0.08	108 (21.5)	109 (21.7)	0.12
Arrhythmia	101 (12.9)	102 (13.0)	0.01	81 (16.1)	76 (15.1)	0.07
Stroke	85 (10.9)	100 (12.8)	0.07	57 (11.3)	72 (14.3)	0.07
Myocardial infarction	46 (5.9)	37 (4.7)	0.05	41 (8.2)	32 (6.4)	0.05
CCI Score, mean (SD)	3.2 (1.8)	3.3 (2.2)	0.06	3.5 (1.9)	3.7 (2.3)	0.16
Medications during the 12-month baseline period, n (%)
RAASi^b	567 (72.4)	565 (72.2)	0.01	383 (76.1)	358 (71.2)	0.03
Cardiovascular medications^c	740 (94.5)	755 (96.4)	0.08	478 (95.0)	484 (96.2)	0.06
SGLT-2i	280 (35.8)	280 (35.8)	0.00	0 (0)	0 (0)	0.00
Other glucose-lowering therapy^d	588 (75.1)	615 (78.5)	0.07	339 (67.4)	353 (70.2)	0.05
NSAID	93 (11.9)	111 (14.2)	0.07	55 (10.9)	68 (13.5)	0.03
Patients with HCRU during the 12-month baseline period, n (%)
Inpatient	163 (20.8)	200 (25.5)	0.12	126 (25.0)	145 (28.8)	0.12
ED	213 (27.2)	243 (31.0)	0.09	150 (29.8)	158 (31.4)	0.06
Per-patient all-cause medical costs during the 12-month baseline period, $
Mean (SD)	14,753.89 (27,687.99)	17,609.56 (32,905.85)	0.10	18,094.58 (32,230.41)	18,040.72 (32,329.06)	0.08
Median (IQR)	4007.23 (1484.98–13,077.77)	3749.44 (1354.39–16,320.28)		4635.28 (1626.56–17,758.90)^|	4088.20 (1370.11–18,832.10)

^aNo baseline SGLT-2i therapy.

^bUse of ACEi, ARB, ARNI, and/or MRA.

^cUse of alpha blocker, beta blocker, calcium channel blocker, anticoagulant, antiplatelet, lipid-lowering drug, loop diuretic, and/or thiazide diuretics.

^dUse of one or more non-SGLT-2i glucose-lowering therapy (metformin, DPP-4i, GLP1-RA, sulfonylurea, insulin, thiazolidinedione).

ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI; angiotensin receptor neprilysin inhibitor; CCI, Charlson Comorbidity Index; DPP-4i, dipeptidyl peptidase-4 inhibitor; ED, emergency department; GLP1-RA, glucagon-like peptide-1 receptor agonist; HCRU, healthcare resource utilization; IQR, interquartile range; MRA, mineralocorticoid receptor antagonist; NSAID, non-steroidal anti-inflammatory drug; RAASi, renin-angiotensin-aldosterone system inhibitor; SD, standard deviation; SGLT-2i, sodium-glucose co-transporter-2 inhibitor; SMD, standardized mean difference.

Figure 1. Patient disposition before propensity score matching (overall population and new-user subgroup).

Note: ^aBaseline period was 12 months before the index date.

^bImmunosuppressive treatment was defined as methotrexate, cyclophosphamide, rituximab, prednisolone, hydroxychloroquine, or mycophenolate.

^cFollow-up period was 6 months after the index date.

^dAt the time of this study, dapagliflozin was the only SGLT-2i indicated for CKD; the non-dapagliflozin cohort excludes patients with possible off-label use of other SGLT-2i for CKD treatment.

CKD, chronic kidney disease; ESKD, end-stage kidney disease; SGLT-2i, sodium-glucose co-transporter-2 inhibitor.

Figure 2. Cardiorenal medical cost^a to payers during 6 months’ follow-up for propensity score-matched patients with stage 3 CKD in the dapagliflozin and non-dapagliflozin cohorts in the (a) overall population and (b) new-user subgroup.

Note: ^aInpatient, emergency department, and outpatient treatment with CKD in any diagnosis position and inpatient hospitalization with heart failure in any diagnosis position.

*P<0.001 vs non-dapagliflozin cohort.

Costs are in 2021 United States dollars. The percent change in cost was calculated as the difference in costs between the dapagliflozin and non-dapagliflozin cohorts divided by the cost for the non-dapagliflozin cohort.

Figure 3. OOP cardiorenal medical cost^a to patients during 6 months’ follow-up for propensity score-matched patients with stage 3 CKD in the dapagliflozin and non-dapagliflozin cohorts in the (a) overall population and (b) new-user subgroup.

Note: ^aInpatient, emergency department, and outpatient treatment with CKD in any diagnosis position and inpatient hospitalization with heart failure in any diagnosis position.

*P = 0.005 vs non-dapagliflozin cohort.

**P = 0.02 vs non-dapagliflozin cohort

Costs are in 2021 United States dollars. The percent change in cost was calculated as the difference in costs between the dapagliflozin and non-dapagliflozin cohorts divided by the cost for the non-dapagliflozin cohort.

CKD, chronic kidney disease; OOP, out-of-pocket.

Figure 4. All-cause medical and pharmacy cost to payers during 6 months’ follow-up for propensity score-matched patients with stage 3 CKD in the (a) overall population and (b) new-user subgroup.

Note : *P < 0.001 vs non-dapagliflozin cohort.

**P = 0.01 vs non-dapagliflozin cohort.

Costs are in 2021 United States dollars. The percent change in cost was calculated as the difference in costs between the dapagliflozin and non-dapagliflozin cohorts divided by the cost for the non-dapagliflozin cohort.

CKD, chronic kidney disease.

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.