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Mesenchymal stromal cell therapy compared to SGLT2-inhibitors and usual care in treating diabetic kidney disease: A cost-effectiveness analysis

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  • Luke E Barry
  • Grainne E Crealey
  • Paul Cockwell
  • Stephen J Elliman
  • Matthew D Griffin
  • Alexander P Maxwell
  • Timothy O’Brien
  • Norberto Perico
  • Ciaran O’Neill

Abstract

Background and objectives: To simulate the cost-effectiveness of Mesenchymal Stromal Cell (MSC) therapy compared to sodium/glucose co-transporter 2 inhibitors (SGLT2i) or usual care (UC) in treating patients with Diabetic Kidney Disease (DKD). Design, setting, participants, and measurements: This Markov-chain Monte Carlo model adopted a societal perspective and simulated 10,000 patients with DKD eligible for MSC therapy alongside UC using a lifetime horizon. This cohort was compared with an SGLT2i alongside UC arm and a UC only arm. Model input data were extracted from the literature. A threshold of $47,000 per quality-adjusted life year and a discount rate of 3% were used. The primary outcome measure was incremental net monetary benefit (INMB). Sensitivity analysis was conducted to examine: parameter uncertainty; threshold effects regarding MSC effectiveness and cost; and INMB according to patient age (71 vs 40 years), sex, and jurisdiction (UK, Italy and Ireland). Results: While MSC was more cost-effective than UC, both the UC and MSC arms were dominated by SLGT2i. Relative to SGLT2i, the INMB’s for MSC and UC were -$4,158 and -$10,085 respectively indicating that SGLT2i, MSC and UC had a 64%, 34% and 1% probability of being cost-effective at the given threshold, respectively. This pattern was consistent across most scenarios; driven by the relatively low cost of SGLT2i and demonstrated class-effect in delaying kidney failure and all-cause mortality. When examining younger patients at baseline, SGLT2i was still the most cost-effective but MSC performed better against UC given the increased lifetime benefit from delaying progression to ESRD. Conclusions: The evidence base regarding the effectiveness of MSC therapy continues to evolve. The potential for these therapies to reverse kidney damage would see large improvements in their cost-effectiveness as would targeting such therapies at younger patients and/or those for whom SGLT2i is contra-indicated.

Suggested Citation

  • Luke E Barry & Grainne E Crealey & Paul Cockwell & Stephen J Elliman & Matthew D Griffin & Alexander P Maxwell & Timothy O’Brien & Norberto Perico & Ciaran O’Neill, 2022. "Mesenchymal stromal cell therapy compared to SGLT2-inhibitors and usual care in treating diabetic kidney disease: A cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 17(11), pages 1-12, November.
    • Handle: RePEc:plo:pone00:0274136
    DOI: 10.1371/journal.pone.0274136
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    References listed on IDEAS

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    1. Gray, Alastair M. & Clarke, Philip M. & Wolstenholme, Jane L. & Wordsworth, Sarah, 2010. "Applied Methods of Cost-effectiveness Analysis in Healthcare," OUP Catalogue, Oxford University Press, number 9780199227280, Decembrie.
    2. Daniel M. Sugrue & Thomas Ward & Sukhvir Rai & Phil McEwan & Heleen G. M. Haalen, 2019. "Economic Modelling of Chronic Kidney Disease: A Systematic Literature Review to Inform Conceptual Model Design," PharmacoEconomics, Springer, vol. 37(12), pages 1451-1468, December.
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