Novel CKD Therapies Proved Cost Effective Across Health Systems

Newer nephroprotective medications for chronic kidney disease (CKD), particularly sodium-glucose cotransporter 2 inhibitors (SGLT2i), were generally found to be cost-effective—and in some cases cost-saving—across a wide range of health care systems and patient populations, according to a systematic review published in PharmacoEconomics.¹

The review synthesized findings from 36 economic evaluations conducted across North America, Europe, Asia, and South America and examined therapies approved for CKD management between 2013 and 2025. Researchers found that most interventions improved quality-adjusted life-years (QALYs), delayed disease progression, and reduced the need for expensive kidney replacement therapy (KRT), including dialysis and transplantation.

“Current evidence indicates that novel nephroprotective therapies for CKD are generally cost-effective, and in some settings cost-saving," the authors wrote. “These findings support their value in both general CKD and diabetic populations and highlight the importance of early treatment adoption to delay disease progression and reduce long-term healthcare costs.”

CKD Burden and Dialysis Costs Drove Need for Economic Data

The review was conducted against the backdrop of rising CKD prevalence and mounting health care expenditures tied to advanced disease management. The authors noted that CKD affects more than 10% of the global population, or more than 800 million people worldwide. Mortality from kidney diseases has also risen sharply over the past 2 decades, driven in part by aging populations and increasing rates of diabetes and hypertension.

Although many people with CKD do not progress to kidney failure, those who do often require dialysis or transplantation, both of which carry substantial long-term costs and morbidity burdens. Prior research has demonstrated clinical benefits from SGLT2i agents such as dapagliflozin, empagliflozin, and canagliflozin, as well as newer therapies including finerenone and semaglutide. However, according to the authors, evidence comparing the economic value of these therapies across health care systems had remained fragmented.

CKD continues to represent a major public health burden in the US, where an estimated 35.5 million adults are living with the condition, according to the CDC.² Many people remain unaware they have kidney disease until it has substantially progressed¹; the agency estimates that as many as 9 in 10 adults with CKD are undiagnosed.² CKD prevalence also rises sharply with age and is disproportionately higher among Black adults, underscoring ongoing disparities in kidney health outcomes and access to early intervention. These trends have heightened interest in therapies that may slow progression to kidney failure and reduce the need for dialysis or transplantation.

To address that gap, investigators of the present review searched PubMed, the Cochrane Library, health technology assessment databases, and reference lists for English-language cost-effectiveness studies published between January 2015 and September 2025.¹ The review ultimately included 36 evaluations after screening 172 initial records.

SGLT2i Frequently Produced QALY Gains and Cost Savings

Most included studies evaluated SGLT2i therapies, particularly dapagliflozin and empagliflozin. Across all analyses, novel therapies generated QALY gains ranging from 0.012 to 1.44 compared with standard of care. Only 3 studies reported incremental cost-effectiveness ratios (ICERs) above the commonly cited $100,000-per-QALY threshold.

Among studies focused on broader CKD populations, 7 of 16 SGLT2i evaluations found the therapies to be cost-saving. The largest savings were reported in the Netherlands, where empagliflozin reduced costs by more than $40,000 compared with standard therapy. Lifetime ICERs for dapagliflozin ranged from approximately $9936 in the UK to $21,148 in Germany and $14,024 in Spain.

Results varied considerably by country and health care system. One US study estimated incremental costs of more than $100,000 for dapagliflozin therapy despite improved outcomes. In contrast, analyses conducted in Thailand, Malaysia, and Canada frequently found SGLT2i therapies to be economically dominant, meaning they improved outcomes while lowering costs.

The authors attributed much of this variability to differences in drug pricing, reimbursement structures, and health care delivery systems.

Advanced CKD Stages Emerged as Major Cost Drivers

The review also highlighted how sharply costs escalated as CKD progressed. Early-stage disease was associated with relatively modest expenditures, but costs rose substantially beginning in stage 3 CKD and increased dramatically once patients reached kidney failure.

In Canada, for example, annual direct costs rose from $378 per patient in stage 4 CKD to $5353 in stage 5 before dialysis initiation, representing a more than 14-fold increase. Dialysis costs were even more substantial, ranging from approximately $35,500 annually for peritoneal dialysis in France to nearly $89,000 annually in Germany.

“These findings confirm that KRT constitutes the dominant driver of CKD-related health care expenditures,” the authors wrote.

The investigators also found that therapies tended to appear more cost-effective in patients with more advanced CKD, likely because these individuals had higher baseline risks for kidney failure and cardiovascular complications. Preventing or delaying dialysis in high-risk populations produced especially large downstream savings.

Finerenone and Other Agents Showed Mixed Economic Results

Finerenone, which was studied primarily in patients with CKD and type 2 diabetes, generally demonstrated favorable economic outcomes. Several studies from Europe and China found the drug to be cost-saving, while others reported ICERs ranging from approximately $14,000 to $28,000 per QALY in the UK and Canada.

However, some therapies produced less favorable results. A US study evaluating sotagliflozin in people with type 1 diabetes estimated an ICER of $119,147 per QALY gained. Sparsentan exceeded conventional cost-effectiveness thresholds at list price but met those thresholds under a patient access pricing arrangement.

Overall, 30 of the 36 included studies concluded that the evaluated intervention was cost-effective in its respective setting.

Limitations Included Modeling Assumptions and Geographic Gaps

The authors acknowledged several limitations. Most analyses relied on long-term economic models rather than direct real-world follow-up, introducing uncertainty around disease progression and treatment effects over time. Many models also assumed constant treatment benefits across CKD stages rather than stage-specific effects.

In addition, the included studies varied substantially in methodology, time horizon, pricing assumptions, and health care perspectives, limiting direct comparisons between countries. No studies from low-income countries met the inclusion criteria, leaving gaps in the understanding of cost-effectiveness in resource-constrained settings.

Still, the review authors concluded that the consistency of findings across health care systems supported broader adoption of nephroprotective therapies earlier in the disease course.

“Therapies that effectively delay CKD progression and kidney failure have the potential to generate substantial economic value,” they wrote.

References

1. Darbà J, Ascanio M, Rodríguez A. Chronic kidney disease (CKD): systematic review of the cost effectiveness of SGLT2 inhibitors and other novel nephroprotective drugs. PharmacoEconomics. 2026;44(7):705-725. doi:10.1007/s40273-026-01611-6
2. Chronic kidney disease in the United States. CDC. Updated March 31, 2026. Accessed May 29, 2026. https://www.cdc.gov/kidney-disease/php/data-research/index.html