Impact of Increased SGLT2 Inhibitor Uptake in CKD Management in Denmark: Modeling National Patient Benefits and Cost Savings

Rationale & Objective: Chronic kidney disease (CKD) poses an increasing global burden for patients and health care providers, driven by aging populations and the rising prevalence of chronic diseases. Despite strong evidence supporting benefits of sodium/glucose cotransporter 2 inhibitors (SGLT2is), uptake remains limited. The objective of this study was to model potential benefits of increased SGLT2i uptake on clinical and economic outcomes of CKD in Denmark. Study Design: A dynamic decision-analytic modeling study with a 10-year time horizon. Setting & Participants: Danish incident and prevalent populations with CKD stages G3-G5 eligible for SGLT2is. Exposure: SGLT2i treatment with uptake rates of 15%, 50%, and 90%. Assumptions about SGLT2i treatment effects were based on the EMPA-KIDNEY trial. Outcomes: The model evaluated benefit on all-cause mortality, quality-adjusted life years, cardiovascular disease, and kidney failure (KF). The broader health care impact was estimated through costs and net monetary benefit. Analytical Approach: A validated Markov state microsimulation model (CKD progression model) using 18 health states, defined by eGFR and urinary albumin-creatinine ratio thresholds defined by Kidney Disease: Improving Global Outcomes (KDIGO). Results: Based on prevalence and incidence of CKD, the model predicts a 30% increase in the population of individuals with CKD stages G3-G5 from 251,946 in 2026 to 328,414 in 2035 with the current practice. SGLT2i uptake of 15%, 50%, and 90% are associated with a 10-year risks of KF of 8.5%, 6.6%, and 4.5%, respectively, and 10-year mortality rate of 54.3%, 53.9%, and 53.5%. This results in a net monetary benefit of 204 and 438 million €, respectively, compared with uptake of 15%. Limitations: The efficacy of SGLT2is was derived from a single randomized controlled trial. Conclusions: Based on a validated CKD progression model, increased SGLT2i uptake in Denmark is associated with increased patient survival and reduced progression to KF, leading to a net benefit on health care spending within a 6-year time horizon. Plain-language Summary: Chronic kidney disease is becoming more common, and many patients do not receive treatments that could slow the worsening of their condition. This motivated us to explore what might happen if more people in Denmark were treated with sodium/glucose cotransporter 2 inhibitors, a therapy shown to benefit individuals with kidney disease. Using a validated model based on real patient data, we estimated how increased use of sodium/glucose cotransporter 2 inhibitors could affect health outcomes over the coming years. The analysis suggests that wider use could help people live longer, delay serious complications, and reduce pressure on the health care system. Our findings highlight that improving access to proven treatments has the potential to benefit both patients and society as kidney disease continues to grow.