A new analysis from the EMPA-KIDNEY clinical trial team has shown that empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i) treatment recommended for people living with chronic kidney disease (CKD), is cost-effective in terms of improving quality of life and reducing healthcare costs. The study is published in eClinicalMedicine.
EMPA-KIDNEY is the largest ever randomised controlled trial of a SGLT2i treatment in people with CKD, involving over 6,600 participants across eight countries. In November 2022, the trial reported that empagliflozin reduced the risk of kidney disease progression or cardiovascular death in people with CKD by 28% and in 2024 the trial reported that empagliflozin’s cardiorenal benefits continued for up to 12 months after it was discontinued. It is now a recommended treatment for CKD in several countries, including Ecuador, Egypt, Peru, Saudi Arabia, Taiwan, the United Arab Emirates, United Kingdom, and the United States of America, as well as in the European Union.
In this study, researchers assessed the impact of empagliflozin on quality of life-adjusted survival, healthcare use and NHS costs in the UK using trial data collected during the two-year treatment period and an additional two years of post-trial follow-up.
Key findings:
- Two years of treatment with empagliflozin improved the number of quality-adjusted life years (QALYs)*, meaning that it resulted in more years of good health for people who were allocated to receive empagliflozin;
- Treatment with empagliflozin also reduced hospital admissions and use of other medications, and led to lower costs for end-stage kidney disease (ESKD) management resulting in total net healthcare cost savings of about £600 over the four years in the trial per person allocated to receive empagliflozin;
- While the probability of cost-effectiveness at the £20,000/QALY threshold was 43% over two years, this rose to 91% over four years due to ongoing cost savings from delayed progression to ESKD;
- The benefits of empagliflozin were consistent across different subgroups, including patients with and without diabetes, and those at varying levels of kidney function and albuminuria (the presence of protein in urine and a sign of reduced kidney function).
Dr Junwen Zhou, Senior Researcher at the Health Economics Research Centre and first author of the study, said ‘Our findings show that empagliflozin improves quality-adjusted survival while also reducing the use and cost of other healthcare. This makes it a highly cost-effective treatment for people with chronic kidney disease. Our analysis has also shown that empagliflozin is associated with larger cost savings in those at higher risk of kidney disease progression.’
Dr Borislava Mihaylova, Associate Professor at the Health Economics Research Centre and senior author of the study, added ‘The benefits seen with two years of empagliflozin treatment during the active-trial and post-trial follow-up periods suggest that even larger health benefits and cost savings are expected with long-term SGLT2i treatment, with potential for significant reductions in kidney failure risk and costs.’
Professor Will Herrington, co-chief investigator of EMPA-KIDNEY, commented ‘Our results support current National Institute for Health and Care Excellence (NICE) recommendations for the use of empagliflozin in CKD management. We hope that these results will encourage more widespread prescription of SGLT2i to patients at risk of CKD progression.’
The researchers note that the trial’s relatively short active treatment period may underestimate the long-term cost-effectiveness of empagliflozin. Furthermore, with generic versions expected to reduce the cost of SGLT2 inhibitors significantly in the near future, even greater cost-effectiveness is anticipated.
These results provide timely and important evidence to support clinical guidelines and inform policy decisions around the use of SGLT2 inhibitors for people living with CKD.
* Quality Adjusted Life Years (QALYs) are a standard metric used to compare the cost-effectiveness of different healthcare interventions. One QALY is equivalent to an additional year gained at full health. Generally, NICE considers medicines costing between £20,000 and £30,000 per additional QALY gained to represent good value for money for the NHS.