Endocrinol Metab.  2024 Aug;39(4):622-631. 10.3803/EnM.2024.1965.

Financial Benefits of Renal Dose-Adjusted Dipeptidyl Peptidase-4 Inhibitors for Patients with Type 2 Diabetes and Chronic Kidney Disease

• Choe HJ
• Ko YH
• Moon SJ
• Ahn CH
• Ha KH
• Lee H
• Bae JH
• Joo HJ
• Lee H
• Son JW
• Kim DJ
• Kim SG
• Kim K
• Cho YM

• KMID: 2558946
• DOI: http://doi.org/10.3803/EnM.2024.1965

Abstract

Background
Dipeptidyl peptidase-4 (DPP4) inhibitors are frequently prescribed for patients with type 2 diabetes; however, their cost can pose a significant barrier for those with impaired kidney function. This study aimed to estimate the economic benefits of substituting non-renal dose-adjusted (NRDA) DPP4 inhibitors with renal dose-adjusted (RDA) DPP4 inhibitors in patients with both impaired kidney function and type 2 diabetes.
Methods
This retrospective cohort study was conducted from January 1, 2012 to December 31, 2018, using data obtained from common data models of five medical centers in Korea. Model 1 applied the prescription pattern of participants with preserved kidney function to those with impaired kidney function. In contrast, model 2 replaced all NRDA DPP4 inhibitors with RDA DPP4 inhibitors, adjusting the doses of RDA DPP4 inhibitors based on individual kidney function. The primary outcome was the cost difference between the two models.
Results
In total, 67,964,996 prescription records were analyzed. NRDA DPP4 inhibitors were more frequently prescribed to patients with impaired kidney function than in those with preserved kidney function (25.7%, 51.3%, 64.3%, and 71.6% in patients with estimated glomerular filtration rates [eGFRs] of ≥60, <60, <45, and <30 mL/min/1.73 m², respectively). When model 1 was applied, the cost savings per year were 7.6% for eGFR <60 mL/min/1.73 m² and 30.4% for eGFR <30 mL/min/1.73 m². According to model 2, 15.4% to 51.2% per year could be saved depending on kidney impairment severity.
Conclusion
Adjusting the doses of RDA DPP4 inhibitors based on individual kidney function could alleviate the economic burden associated with medical expenses.

Keyword

Cost savings; Dipeptidyl-peptidase IV inhibitors; Renal insufficiency, chronic; Diabetes mellitus, type 2; Common data model

Figure

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  Fig. 1. Consolidated Standards of Reporting Trials (CONSORT) diagram. Hospitals A, B, C, D, and E are Ajou University Hospital, Ewha Womans University Mokdong Hospital, Korea University Anam Hospital, Seoul National University Hospital, and Seoul National University Bundang Hospital, in an arbitrary order. DPP4, dipeptidyl peptidase-4.

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  Fig. 2. Patterns of dipeptidyl peptidase-4 inhibitor (DPP4i) prescriptions. Each bar is stacked to represent prescription rates for renal dose-adjusted (RDA) and non-renal dose-adjusted (NRDA) DPP4 inhibitors according to the estimated glomerular filtration rate (eGFR) cutoff values of 60 (left), 45 (middle), and 30 mL/min/1.73 m2 (right). (A) All patients. (B) Patients who were prescribed DPP4 inhibitors in outpatient clinics. (C) Patients who were prescribed DPP4 inhibitors during hospitalization.

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  Fig. 3. Economic benefits of prescribing renal dose-adjusted (RDA) dipeptidyl peptidase-4 (DPP4) inhibitors in patients with impaired kidney function. Each bar is stacked to represent specific DPP4 inhibitors. RDA DPP4 inhibitors are colored in red shades and non-renal dose-adjusted (NRDA) DPP4 inhibitors in blue shades. The subcolumns on the left side represent the current cost ($) spent on DPP4 inhibitors according to the estimated glomerular filtration rate (eGFR) cutoff values of 60, 45, and 30 mL/min/1.73 m2. The subcolumns in the middle and on the right side represent the costs estimated by applying model 1 and model 2, respectively.

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  Fig. 4. Economic benefits of prescribing renal dose-adjusted dipeptidyl peptidase-4 inhibitors in patients with impaired kidney function per year (2012 to 2018). The annual cost-saving effect estimated by applying model 1 (blue) and model 2 (light blue) in patients with estimated glomerular filtration rate (eGFRs) (A) <60, (B) <45, and (C) <30 mL/min/1.73 m2.

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