<b><i>Introduction:</i></b> Distal renal tubular acidosis (dRTA), or RTA type 1, a rare inherited or acquired disease, is a disorder of the distal tubule caused by impaired urinary acid secretion. Due to associated conditions and nonspecific symptoms, dRTA may go undetected. This analysis aims to estimate the prevalence of dRTA in the UK Clinical Practice Research Datalink (CPRD) databases and extrapolate it to European Union Five (EU5) populations. <b><i>Methods:</i></b> A retrospective analysis was conducted using the CPRD GOLD database and linked Hospital Episode Statistics (HES) data to identify diagnosed and potentially undiagnosed or miscoded patients (suspected patients). Patients’ records with at least one diagnosis code for dRTA, RTA, specific autoimmune diseases, or renal disorders recorded between January 1987 and November 2017 were obtained and analyzed. An algorithm was developed to detect potentially undiagnosed/miscoded dRTA, based on associated conditions and prescriptions. <b><i>Results:</i></b> A total of 216 patients with diagnosis of RTA or dRTA were identified (with 98 linked to hospital data), and 447 patients were identified as having suspected dRTA. dRTA prevalence for 2017 was estimated between 0.46 (recorded cases, of which 22.1% were considered primary) and 1.60 when including suspected cases (7.6% primary) per 10,000 people. Prescription and clinical records of diagnosed patients revealed a wide range of comorbidities and a need for pharmacological treatment to manage associated symptoms. <b><i>Conclusion:</i></b> The study provides new estimates of dRTA prevalence in Europe and suggests that patients may often be unreported or miscoded, potentially confounding appropriate disease management.
An interdisciplinary program of secondary prevention of chronic kidney disease was implemented in a reference hospital of the social security of Peru in 2013, with the aim to reduce the incidence of dialysis and overall mortality in chronic kidney disease (CKD) patients. A previous study showed the intervention provided a protection of 58% to progress to dialysis compared to the standard care. We aim to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness. Methods: We use a Markov model of three health stages to simulate for 30 years the cost associated with intervention and standard of care alternative, as well as years lived free of dialysis (YL) and Quality Adjusted Life Years (QALY). We use a simulated cohort with the same structure as the original dataset. Cost were estimated since the payer perspective. Results: We found an Incremental Cost-Effectiveness Ratio (ICER) per YL adverted of $149 and per QALY gained of $1,752. From a one-way analysis, the ICER showed high sensitivity to changes in treatment effect, cost of treatment and cost of dialysis, out of eight parameters included in the analysis. Conclusions: We found our model robust to internal validity due to good representation of the target cohort and low uncertainty in the sources from key parameters in the model. Our results present evidence of a cost-effective strategy in a Regional context of reduced evidence of prevention strategies for CKD. We hope our results help to advocate for more similar strategies.
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