{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:38:24Z","timestamp":1785523104716,"version":"3.56.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Hochschule Heilbronn"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cost Eff Resour Alloc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes and its associated complications like nephropathy impose a serious burden on health systems. Several blood glucose-lowering medications have shown to be likely to provide nephroprotective properties, delaying or preventing the onset of kidney damage. Kidney-specific health-economic evaluations, comparing different agents, remain rare for Germany.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov-microsimulation model was developed to obtain the perspective of the German statutory health system regarding cost-effectiveness. The model consists of five health states representing varying degrees of kidney damage with transition probabilities, utilities and costs being taken from published literature. Patient age was set to 62.8 years in the primary cohort; an additional analysis scenario was created with a start age of 50 years. The model outcomes life expectancy, quality adjusted life years, costs and net monetary benefit were discounted at 3% at a willingness-to-pay threshold of 100,000\u20ac per quality adjusted life year gained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Quality adjusted life years increased from 10.28 years in standard care to 10.48 years with Empagliflozin, 10.58 years with Semaglutide and 10.75 years with Tirzepatide all added on top of standard care. Life expectancy increased from 13.36 years in the base case to 13.66 years, 13.76 years and 14.00 years with Empagliflozin, Semaglutide and Tirzepatide respectively. Total direct cost amounted to 66,343.64\u20ac in the base case, 79,767.42\u20ac with Empagliflozin, 84,328.59\u20ac with Semaglutide and to 155,992.59\u20ac with Tirzepatide. The net monetary benefit was calculated to be 961,445.98\u20ac in the base case, 968,406.95\u20ac, 973,647.74\u20ac and 919,972.95\u20ac with Empagliflozin, Semaglutide and Tirzepatide respectively. Multiple one-way sensitivity analyses were performed. The most influencing factors on the cost-effectiveness were found to be quality of life in the type 2 diabetes state and intervention cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this study, the application of second-line glucose-lowering medication in type 2 diabetes patients led to relevant medical improvements regarding kidney damage at higher expenditures. At the chosen willingness-to-pay threshold Empagliflozin and Semaglutide remained cost-effective in all scenarios. Patient age and sex did not change the health-economic implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12962-026-00801-5","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:41:58Z","timestamp":1785148918000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The cost-effectiveness of second line diabetes medication added to standard therapy in preventing type 2 diabetes related nephropathy in Germany"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5419-6841","authenticated-orcid":false,"given":"Hanni","family":"Hille","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7048-5088","authenticated-orcid":false,"given":"Wendelin","family":"Schramm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7460-3562","authenticated-orcid":false,"given":"Ahmed","family":"Bounekkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"issue":"10","key":"801_CR1","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1038\/nrendo.2016.105","volume":"12","author":"KGA Paul Zimmet","year":"2016","unstructured":"Paul Zimmet KGA, Dianna J, Magliano, Peter H, Bennett. 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