Date of download: 7/11/2016 From: Cost-Effectiveness of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease Ann Intern Med. 2013;159(6): doi: / Schematic of the Markov model of kidney disease. Stage 3 CKD was subdivided into stages 3A and 3B (not shown). We used SAS, version 9.2 (SAS Institute, Cary, North Carolina), in our microsimulation to convert estimated GFR progression to CKD stage progression in autosomal dominant polycystic kidney disease and then used TreeAge Pro 2009 (TreeAge Software, Williamstown, Massachusetts) to do cost-effectiveness analyses. CKD = chronic kidney disease; ESRD = end-stage renal disease; GFR = glomerular filtration rate. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 7/11/2016 From: Cost-Effectiveness of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease Ann Intern Med. 2013;159(6): doi: / Simulated mortality and age of ESRD onset with and without tolvaptan. Tolvaptan therapy prolongs median age to development of ESRD by 6.5 years and extends life by an average of 2.6 years. ESRD = end-stage renal disease. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 7/11/2016 From: Cost-Effectiveness of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease Ann Intern Med. 2013;159(6): doi: / Cost-effectiveness under different model assumptions. Tolvaptan was less cost-effective with slower rates of baseline kidney disease progression. Tolvaptan cost less than $ per QALY gained if 95 mg per day were offered at $1155 or less per month (approximately where the dotted $ WTP line crosses the lines for men and women). The decline in estimated GFR from a cohort of patients with ADPKD was −2.4 mL/min/1.73 m 2 per year (3). Base-case decline in eGFR was −3.7 mL/min/1.73 m 2 per year, which was seen in the placebo group of TEMPO (7). The $ and $ WTP lines represent societal WTP thresholds (the amount of money society would be willing to pay to increase quality-adjusted life expectancy by 1 year). The assumed base-case cost of $5760 per month for 95 mg of tolvaptan equals the current cost of 30-mg tablets. The current cost of 95 mg of tolvaptan was $ based on the current cost of 30-mg tablets. ADPKD = autosomal dominant polycystic kidney disease; CKD = chronic kidney disease; GFR = glomerular filtration rate; ICER = incremental cost-effectiveness ratio; QALY = quality- adjusted life-year; TEMPO = Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes; WTP = willingness to pay. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians