{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:03:53Z","timestamp":1784559833938,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus complicated with chronic kidney disease (T2DM-CKD) is a common and severe complication of T2DM that predisposes patients to end-stage renal disease (ESRD), substantially increasing mortality risk and long-term medical economic burden. Currently, SGLT-2 inhibitors are used as the foundational treatment regimen in clinical practice. As validated by the global multicenter randomized controlled CONFIDENCE trial, simultaneous initiation of finerenone plus an SGLT-2 inhibitor can further enhance renal protection and delay kidney disease progression. Despite these advancements, long-term pharmacoeconomic data supporting this combination regimen in the Chinese population remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>From the perspective of China\u2019s healthcare system, this study aimed to evaluate the cost-utility of the simultaneous initiation of finerenone and empagliflozin versus empagliflozin monotherapy in T2DM-CKD patients, based on the CONFIDENCE trial design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A Markov model was constructed to simulate the natural history of T2DM-CKD. The model cycle was 1 year, with a simulation time horizon of 30 years. The willingness-to-pay (WTP) threshold was set at three times China\u2019s 2025\n                      <jats:italic>per capita<\/jats:italic>\n                      GDP (\u00a5299,100\/QALY). Base-case analysis was performed, followed by one-way and probabilistic sensitivity analyses to assess the robustness of results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Base-case analysis revealed that the incremental cost-effectiveness ratio (ICER, a measure comparing the cost to the health benefit gained) of the finerenone plus empagliflozin regimen was \u00a535,082.44\/QALY (quality-adjusted life year), well below the WTP (willingness-to-pay) threshold. One-way sensitivity analysis indicated that the kidney disease progression coefficient (which measures the rate of worsening kidney disease) and the cost of finerenone were the most influential parameters; all parameter fluctuations within reasonable ranges retained the cost-effectiveness advantage. Probabilistic sensitivity analysis showed that the combination regimen was acceptable in 99.1% of 1,000 Monte Carlo simulations (computer-generated scenarios that model uncertainty), with all incremental QALYs positive, indicating highly robust results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared with empagliflozin monotherapy, the combined initiation of finerenone plus empagliflozin offers significant cost-utility advantages in treating T2DM-CKD. These findings provide high-quality evidence for standardized clinical care, rational pharmacotherapy, the formulation of medical insurance policies, and optimal health resource allocation in Chinese patients with T2DM-CKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1847907","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:32:13Z","timestamp":1784557933000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-utility analysis of simultaneous initiation of finerenone and empagliflozin for type 2 diabetes mellitus complicated with chronic kidney disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Qiang","family":"Liu","sequence":"first","affiliation":[{"name":"School of Business Administration, Shenyang Pharmaceutical University","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengning","family":"Chuan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruobei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longbing","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1093\/eurheartj\/ehab886","article-title":"Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis","volume":"43","author":"Agarwal","year":"2022","journal-title":"Eur. 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