1041-P: Assessing the Value of Managing Diabetic Kidney Disease from a U.S. Health Care Perspective

Introduction: The management of diabetic kidney disease (DKD) is associated with considerable resource utilization. The objective of this study was to estimate the economic value associated with modifying the progression of DKD by attenuating the rate of decline of eGFR. Methods: We developed a deterministic model utilizing published estimates of type 2 diabetes and chronic kidney disease (CKD) stratified by stages: stage 1/2, stage 3a, stage 3b and stage 4/5. Patient characteristics and mean annual decline in eGFR were aligned to the placebo arm of DECLARE-TIMI 58 (-2.44 ml/min/1.732). Diabetes-specific and all-cause mortality were captured using UKPDS risk equations. CKD stage-specific costs and changes in health utility were drawn from US published sources. Costs (indexed to 2023) and quality adjusted life years (QALYs) were both discounted at 3%. Results: The table illustrates the absolute lifetime costs/QALYs associated with the natural history of DKD, and the change in costs/QALYs from attenuating the rate of eGFR decline. Discussion: Attenuating the decline of eGFR in DKD at the population level has the greatest health gain and cost saving in early disease stages. On an individual basis, optimal cost saving and health gains occur at stage 3; in stage 4/5 attenuating eGFR decline results in health gain, but also additional costs due to the cost of managing advanced DKD.