(372) A retrospective cohort study examining the real-world disease progression, HCRU, and costs among patients with T2D with newly diagnosed CKD stage III or IV with and without finerenone use

Background: : Finerenone (FIN), a non-steroidal mineralocorticoid receptor antagonist approved in 2021, demonstrated promising efficacy in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

Objective: : To characterize the progression of disease, HCRU, and costs of T2D patients after CKD stage III or IV diagnosis with and without FIN.

Methods: : A retrospective cohort study of T2D patients newly diagnosed with CKD stage III or IV from Optum Clinformatics Database between 07/2021 and 06/2023 was conducted. A 12-month continuous lookback and follow-up period were used to identify demographics, index diagnoses, incident heart failure (HF), atrial fibrillation (AF), CKD stage progression, HCRU, and costs. A 6-month washout period identified incident FIN users, and 3 months of FIN use was required. Proportions and means (SD) are reported for HCRU and costs.

Results: : The FIN and non-FIN cohorts contained 424 and 161,880 patients, respectively. Baseline CKD stage, CCI score, gender, and use of steroidal mineralocorticoid receptor antagonist during the lookback period were similar between cohorts. The FIN cohort, however, had a higher prevalence of other medication classes for CKD/T2D. Other differences between FIN and non-FIN cohorts at baseline included age (71 and 75), prevalence of HF (18% and 20%), and AF (13% and 16%). After follow-up, incident HF was 12% in the FIN cohort and 19% in the non-FIN cohort. Incident AF was 4% in the FIN cohort and 10% in the non-FIN cohort. Progression from CKD stage III to IV was 11% in the FIN cohort and 6% in the non-FIN cohort. Progression to ESRD from stage III or IV was 1% and 2% in the FIN group and 7% and 19% in the non-FIN group. Mean inpatient visits were 2.5 (7.5) in the FIN group and 4.9 (12.3) in the non-FIN group, corresponding to mean inpatient costs of $11,774 ($37,907) and $23,075 ($54,591). Mean outpatient costs were $19,544 ($21,779) in the FIN group and $24,255 ($40,534) in the non-FIN group. These costs corresponded to the following mean HCRU measures among the FIN and non-FIN groups: ED visits 0.9 (1.9) and 1.3 (2.3), outpatient visits 5.9 (7.9) and 7.4 (10.9), and office visits 19 (11.7) and 16.3 (13.6). In the FIN and non-FIN groups, mean pharmacy costs were $20,631 ($18,605) and $7,594 ($18,367). Mean total costs for the FIN and non-FIN groups were $51,949 and $54,924, respectively.

Conclusions: : In this analysis, T2D patients with newly diagnosed CKD stage III and IV who received FIN were associated with lower incident HF, AF, and progression to ESRD. Although pharmacy costs were higher, HCRU shifts yielded similar total costs.

Sponsorship:: Bayer