Evidence mapPaperPMID 40739365Full record

ArticleDiabetologia2025

Health economic evaluation of a risk-stratified intervention in diabetic kidney disease.

Tosha A Kalhan, Miyang Luo, Jia Hui Chai, E Shyong Tai, Su Chi Lim, Thomas M Coffman, Kavita Venkataraman

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Article in Diabetologia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Tosha A Kalhan *Saw Swee Hock School of Public Health, National University Singapore, Singapore, Republic of Singapore.ORCID http://orcid.org/0009-0001-9429-2627
Miyang Luo *Saw Swee Hock School of Public Health, National University Singapore, Singapore, Republic of Singapore.
Jia Hui ChaiSaw Swee Hock School of Public Health, National University Singapore, Singapore, Republic of Singapore.
E Shyong TaiSaw Swee Hock School of Public Health, National University Singapore, Singapore, Republic of Singapore.
Su Chi LimSaw Swee Hock School of Public Health, National University Singapore, Singapore, Republic of Singapore.
Thomas M CoffmanCardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Republic of Singapore.
Kavita VenkataramanSaw Swee Hock School of Public Health, National University Singapore, Singapore, Republic of Singapore. ephkv@nus.edu.sg.ORCID http://orcid.org/0000-0002-3139-6998

Funding

Biomedical Research Council BMRC/05/1/21/19/425National Medical Research Council NMRC/0850/2004National Medical Research Council OFLCG/001/2017
6 · The paper itself

Abstract

aims/hypothesisThe study aimed to model the progression of diabetic kidney disease (DKD) in a multi-ethnic Asian population and evaluate the economic impact of a risk-stratified intervention for DKD management.

methodsUsing the Singapore Diabetic Cohort (N=9660), multi-state Markov models were constructed to derive chronic kidney disease (CKD) stage-specific transition probabilities for disease progression based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. These were internally validated in 50% training and 50% testing datasets and further validated in national administrative datasets (N=73,256). A cost-effectiveness and budget impact analysis for a hypothetical intervention of sodium-glucose cotransporter 2 inhibitors (SGLT2is) was conducted from a healthcare system perspective, across different time horizons, in low-risk (G0-G2) and high-risk individuals (G3-G4) based on eGFR-defined DKD risk stages.

resultsAnnually, more than half of the participants (53.0-88.8%) stayed in the same DKD stage, with the probabilities of progressing or regressing to the next DKD stage being highest between stages G0 and G1. The SGLT2i intervention was cost-effective when given in low-risk, but not in high-risk, individuals with type 2 diabetes in both the short and the long term. Additionally, implementing the SGLT2i intervention would incur a 5 year cumulative cost increase of 41.5%, assuming an annual 5% increase in market uptake. CONCLUSIONS/

interpretationWe developed a robust model of DKD progression based on real-world data and demonstrated its value through economic modelling of risk-stratified interventions with known effectiveness. This model can aid policymakers and health professionals in evaluating population-level interventions for evidence-based policy decisions.

Indexed as

Diabetic NephropathiesAdultAgedCost-Benefit AnalysisDiabetes Mellitus, Type 2Disease ProgressionFemaleGlomerular Filtration RateHumansMaleMarkov ChainsMiddle AgedRenal Insufficiency, ChronicSingaporeSodium-Glucose Transporter 2 InhibitorsSodium-Glucose Transporter 2 InhibitorsAsian populationBudget impactChronic kidney diseaseCost-effectivenessDiabetic kidney diseaseEconomic evaluationHealth policyMarkov modelRisk stratificationSGLT2 inhibitors

Identifiers

PMID40739365

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.