Abstract: TH-PO1043
Effects of Empagliflozin on Health Care Use and Quality of Life in CKD in the United Kingdom: Results from EMPA-KIDNEY
Session Information
- CKD: Therapeutic Advances
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Zhou, Junwen, Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Mihaylova, Borislava N., Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
Group or Team Name
- On behalf of the EMPA-KIDNEY Collaborative Group.
Background
In EMPA-KIDNEY, empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease at risk of progression. We aimed to estimate the effects on within-trial healthcare use and health-related quality of life (QoL).
Methods
6609 participants were randomly assigned to empagliflozin 10 mg daily or placebo and followed for a median of 2.0 (IQR 1.5-2.4) years. We estimated the effects of allocation to empagliflozin on healthcare use and costs (2022 UK£), including hospital admissions, concomitant medications, and kidney replacement therapy, and on QoL using shared parameter (analyzing outcomes together with time to death) or negative binomial models. These models informed estimates of the net effects of empagliflozin on healthcare use and costs and quality-adjusted life years (QALYs) over 2.5 years using 3.5%/year discount rate.
Results
Allocation to empagliflozin resulted in fewer hospital admissions (hazard ratio 0.86, 95% confidence interval 0.78-0.95). There were fewer days on (rate ratio (RR) 0.98, 0.95-1.00) and lower cost of (RR 0.90, 0.85-0.96) concomitant medications. Only a small number of participants initiated kidney replacement therapy and there was no statistically significant difference in these costs (RR 0.74, 0.33-1.69). Overall over 2.5 years, the estimated net cost of healthcare use was £353 (8-698) and additional QALYs were 0.016 (0.001-0.032) per participant allocated empagliflozin (Table).
Conclusion
In EMPA-KIDNEY and based on UK costs, allocation to empagliflozin over 2.5 years reduced other healthcare related costs, offsetting about two-thirds of empagliflozin costs. Ongoing post-trial follow-up will provide useful information on longer-term effects.
Effects of empagliflozin on healthcare use and quality-adjusted life years (QALYs) over 2.5 years in EMPA-KIDNEY
| Days per person over 2.5 years, Mean (95%CIs) | Costs or QALY per person over 2.5 years, Mean (95%CIs) | |||||
| Empagliflozin | Placebo | Difference | Empagliflozin | Placebo | Difference | |
| Total healthcare use (including empagliflozin) | - | - | - | £4438 (4215, 4660) | £4084 (3834, 4335) | £353 (8, 698) |
| Hospital admissions | 5.22 (4.61, 5.83) | 6.24 (5.46, 7.01) | -1.01 (-2.09, 0.07) | £1222 (1088, 1357) | £1490 (1326, 1655) | -£268 (-499, -37) |
| Individual concomitant medications* | 4312 (4228, 4396) | 4396 (4309, 4483) | -84 (-216, 47) | £1505 (1434, 1576) | £1663 (1584, 1741) | -£158 (-258, -57) |
| Kidney replacement therapy | 9.78 (7.52, 12.00) | 12.60 (10.29, 14.92) | -2.82 (-6.04, 0.40) | £694 (532, 856) | £931 (759, 1104) | -£237 (-472, -2) |
| Study empagliflozin | 790 (765, 815) | - | 790 (765, 815) | £1016 (1006, 1026) | - | £1016 (1006, 1026) |
| Quality-adjusted life years (QALYs) | - | - | - | 2.014 (2.000, 2.029) | 1.998 (1.983, 2.013) | 0.016 (0.001, 0.032) |
*Each day on individual medication contributes a ‘medication day’ (e.g. a person on 5 medications/day accumulates 5 medication days).
Funding
- Commercial Support – EMPA-KIDNEY was funded by a grant to the University of Oxford from Boehringer Ingelheim and Eli Lilly.