Objectives: To demonstrate the cost-effectiveness of empagliflozin+Standard of care (SoC) versus SoC alone for the management of adult patients with Chronic Kidney Disease (CKD) in Greece.

Methods: A Markov state microsimulation model with several health state transitions, over a life-time horizon was locally adapted, from a public payer perspective. Model’s health states were defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification. The evolution of estimated glomerular filtration ratio (eGFR) and urine albumin-creatinine ratio (uACR) are used to project CKD progression and the occurrence of a broad range of complications. Patient baseline characteristics, distribution across KDIGO health states, and treatment effects health state dependent in eGFR and uACR were derived from EMPA-KIDNEY trial. Efficacy and safety data were received from the EMPA-KIDNEY trial and public literature. Only direct medical costs related to drug acquisition, disease management and adverse events costs, were considered in the analysis (€,2023). One-way, probabilistic sensitivity analysis and scenario analyses were conducted. Annual discounting rates of 3.5% were applied on costs and outcomes. The time horizon was 50 years.

Results: The analysis showed that over a lifetime horizon, empagliflozin+SoC was associated with additional total cost per patient of €246, compared to SoC alone (€61,944 and €61,698). Combining health and economic outcomes, the incremental analysis showed that empagliflozin+SoC was a cost-effective strategy compared to SoC alone, resulting to an ICER of €255.92 per QALY gained, which is under the defined willingness-to-pay (WTP) threshold of €34,000 per QALY gained (i.e two times GDP per capita of Greece). Moreover, findings of sensitivity analyses confirmed the robustness of base case results highlighting the cost-effective profile of empagliflozin+SoC versus SoC alone.

Conclusions: Empagliflozin added to SoC was estimated to be a highly cost-effective treatment option for the treatment of adults with CKD compared to Soc in Greece.