Breakthrough Treatment with finerenone for Advanced Kidney Disease and Diabetes Cost-Effective

In the Netherlands, where the healthcare system grapples with the staggering burden of over one million patients combating type 2 diabetes (T2D), a significant breakthrough has emerged. A study evaluating the cost-effectiveness of integrating finerenone, a promising therapeutic addition to standard care, offers hope for patients with advanced chronic kidney disease (CKD) and T2D. The study results were published in the journal Cardiovascular Diabetology. 

T2D often brings along the ominous companion of CKD, affecting approximately 36% of patients in the Netherlands. The annual medical costs associated with T2D and CKD are a considerable financial strain, totaling around €1.3 billion and €805 million, respectively. The FIDELIO-DKD trial, a landmark investigation, showcased that the inclusion of finerenone in the standard of care (SoC) regimen significantly reduces the risk of CKD progression and cardiovascular (CV) events in patients dealing with CKD stages 2–4 linked to T2D.

To delve deeper into the potential impact of finerenone on healthcare economics, the study employed the validated FINE-CKD model. This Markov cohort model simulates the lifelong journey of patients, focusing on outcomes related to CV events and renal replacement therapy. The researchers tailored the model to reflect the Dutch societal perspective, considering both clinical effectiveness and economic implications.

Findings: 

• Results from the study paint a promising picture. When finerenone is integrated into the SoC, patients experience an extension in the time free from CV events and renal replacement therapy, translating to 0.20 additional quality-adjusted life years (QALYs).
• Perhaps even more compelling is the cost-saving aspect: finerenone led to a €6136 decrease in total lifetime costs per patient compared to SoC alone.
• This financial benefit stems from the significant reduction in renal and CV events, showcasing finerenone as a dominant treatment option.
• The study found that finerenone, when added to SoC, has an 83% probability of being a dominant strategy and a 93% probability of being cost-effective, particularly at a willingness-to-pay threshold of €20,000.

The implications of this study are groundbreaking, not just for patients facing the challenging intersection of T2D and advanced CKD but also for the broader healthcare system. By demonstrating that the integration of finerenone not only improves patient outcomes but also yields substantial cost savings, this research paves the way for more widespread adoption of this innovative treatment approach. In essence, the study offers a glimmer of hope for those navigating the complexities of diabetes and advanced kidney disease, showcasing that cutting-edge treatments can not only enhance lives but also contribute to the economic sustainability of healthcare systems. 

Further reading: 

Quist, S.W., van Schoonhoven, A.V., Bakker, S.J.L. et al. Cost-effectiveness of finerenone in chronic kidney disease associated with type 2 diabetes in The Netherlands. Cardiovasc Diabetol 22, 328 (2023). https://doi.org/10.1186/s12933-023-02053-6