Cost-utility analysis of empagliflozin on chronic kidney disease progression in Thailand
Creators: name: Dilokthornsakul, Piyameth
name: Susantitaphong, Paweena
name: Satirapoj, Bancha
name: Singhan, Wanchana
name: Ophascharoensuk, Vuddhidej
Publisher: name: Taylor & Francis
Year: 2025
Subjects: subject: Medicine
subject: Pharmacology
subject: Sociology
subject: FOS: Sociology
subject: Biological Sciences not elsewhere classified
subject: Marine Biology
subject: Science Policy

description: The prevalence of chronic kidney disease (CKD) in Thailand is high and kidney disease progression remains a problem. Empagliflozin has been known to be used to slow CKD progression, but its accessibility remains limited. This study aimed to assess the cost-utility of empagliflozin for CKD progression in Thailand. A state-transition model was developed consisting of eight health states: five eGFR health states (G2, G3a, G3b, G4, and G5), dialysis, kidney transplantation, and death. Empagliflozin 10 mg was assessed as an add-on treatment to standard of care (SoC). The efficacy of empagliflozin was derived from the EMPA-KIDNEY trial, while other inputs were obtained from a comprehensive literature review. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) was calculated. A probabilistic sensitivity analysis (PSA) was performed to explore uncertainties. Empagliflozin could improve QALYs by 0.62 and 0.71 for patients with CKD without and with diabetes mellitus (DM) compared with SoC, respectively. However, it required higher total lifetime costs of 77,966 Thai baht (THB) and 59,454 THB for patients with CKD without and with DM, respectively. The ICER for CKD without DM was 126,201 THB/QALY, while the ICER for CKD with DM was 83,473 THB/QALY. The PSA indicated that empagliflozin had a 64.00% probability of being cost-effective for CKD without DM and an 89.18% probability for CKD with DM. An important limitation was that the treatment effects of empagliflozin were derived from the EMPA-KIDNEY, which was conducted in DM patients and assumed to be the same for non-DM patients because of the limited evidence in non-DM patients. At the current willingness-to-pay threshold of 160,000 THB/QALY, empagliflozin was cost-effective for treating patients with CKD without or with DM. Chronic kidney disease (CKD) is a major health issue in Thailand, and finding effective treatments to slow its progression is important. Empagliflozin, a medication known to help with CKD, is not widely available. This study looked at whether using empagliflozin along with standard treatment is worth the cost in Thailand. Researchers created a model to track how CKD progresses in patients. They used clinical trial data and other research to estimate the benefits and costs of adding empagliflozin to standard care. The study found that empagliflozin helped patients live longer with a better quality-of-life, adding about 0.6–0.7 extra years of good health. However, it also increased lifetime medical costs by around 60,000 to 78,000 Thai baht. When comparing the extra cost to the health benefits, the analysis showed that empagliflozin is likely a cost-effective treatment, especially for people with diabetes. Overall, regarding Thailand’s standard for determining if a treatment is worth the cost, empagliflozin is considered a good investment for CKD patients, whether they have diabetes or not.