Early detection of chronic renal disease: coordinated work between primary and specialized care in an ambulatory renal network of Peru

Bravo-Zúñiga, Jessica; Gálvez-Inga, Jungmei; Carrillo-Onofre, Pamela; Chávez-Gómez, Ricardo; Castro-Monteverde, Paul

doi:10.1590/2175-8239-jbn-2018-0101

Cited by 15 publications

(24 citation statements)

References 28 publications

(22 reference statements)

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“…Embedded in this context and considering the recommendations of the WHO, the Renal Health Unit of the E. Rebagliati National Hospital, from Peru's Social Security -EsSalud began the implementation of a secondary prevention plan in 2013. This intervention focuses on multidisciplinary management (including physician, nurse, nutritionist) of patients with risk factors for CKD such as diabetes, hypertension and age over 55, with the aim of reducing the progression of CKD, controlling underlying diseases and reducing overall mortality 12 . The aim of this study was to evaluate the effectiveness of adherence to a renal health program (RHP) in reducing mortality and progression to hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

“…Inmerso en este contexto nacional y considerando las recomendaciones de la OMS, la Unidad de Salud Renal del Hospital Nacional Edgardo Rebagliati, de la Seguridad Social de Perú (EsSalud), comenzó la implementación de un plan de prevención secundaria en 2013. Esta intervención se centra en un manejo multidisciplinario de pacientes con factores de riesgo para la ERC como diabetes, hipertensión y edad mayor de 55 años, con la finalidad de reducir la progresión de ERC, controlar las enfermedades de fondo y reducir la mortalidad general 12 . El objetivo de este estudio fue evaluar la efectividad de la adherencia a un programa de salud renal (PSR) en la reducción de mortalidad y progresión a hemodiálisis.…”

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Effectiveness of adherence to a renal health program in a health network in Peru

et al. 2020

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OBJECTIVE: To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS: We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS: A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41–0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57–0.83). CONCLUSIONS: The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.

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confidence: 99%

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Effectiveness of adherence to a renal health program in a health network in Peru

et al. 2020

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“…This holistic approximation to the CKD requires coordinated efforts between the primary and the specialized care and hence aligns with the evidence that this approach is an effective way to detect atrisk patients (6).…”

Section: Introductionmentioning

confidence: 58%

Cost-Effectiveness Analysis of A Program to Delay Progression to Dialysis and Death Among CKD Patients in Lima, Peru

Saldarriaga¹,

Bravo-Zúñiga²,

Hurtado-Roca³

et al. 2020

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Background. The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients starting dialysis and overall mortality. A previous study found that adhered patients have 58% protection against progression to dialysis compared to non-adhered. Objective. We aim to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. Methods. We use a Markov model of three health stages to simulate for 30 years the cost associated with RHP and usual care, as well as years lived free of dialysis (YL) and Quality Adjusted Life Years (QALY). Costs were estimated from the payer perspective. We conduct a Probabilistic Sensitivity Analysis (PSA) to assess the robustness of our estimates. Results. We found that the RHP is a cost-saving alternative compared to usual care, with a per person difference of $-782.73in costs and 0.04 in QALYs. The Incremental Cost-Effectiveness Ratio (ICER) per QALY is $-21,660. From a PSA, RHP holds cost-saving under 999 out of 1,000 evaluated scenarios. Discussion. Our results show the lifetime economic value of a case-management intervention for CKD patients to delay its progression to dialysis. The RHP is cost-saving compared to usual care, with a negative ICER per QALY robust to different scenarios. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of prevention and early referral strategies in CKD patients.

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“…Embedded in this context, the Renal Health Unit of the Hospital E. Rebagliati—the biggest facility of the Peruvian social health insurance (EsSalud)—implemented a secondary prevention intervention in 2013 called the Renal Health Program (RHP) [ 7 ]. The RHP aimed to reduce the incidence of patients progressing to dialysis and overall mortality.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru

Saldarriaga

Bravo-Zúñiga

Hurtado-Roca

et al. 2021

Cost Eff Resour Alloc

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Background The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients initiating dialysis and overall mortality. A previous study found that adherent patients have 58% protection against progression to dialysis compared to non-adherent. The main objective of the study was to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. Methods We use a Markov model of three health stages to simulate disease progression among chronic kidney disease patients in Lima, Peru. The simulation time-horizon was 30 years to capture the lifetime cost and health consequences comparing the RHP to usual care. Costs were estimated from the payer perspective using institutional data. Health outcomes included years lived free of dialysis (YL) and quality adjusted life years (QALY). We conducted a probabilistic sensitivity analysis (PSA) to assess the robustness of our estimates against parameter uncertainty. Results We found that the RHP was dominant—cost-saving and more effective—compared to usual care. The RHP was 783USD cheaper than the standard of care and created 0.04 additional QALYs, per person. The Incremental Cost-Effectiveness Ratio (ICER) showed a cost per QALY gained of $21,660USD. In the PSA the RHP was dominant in 996 out of 1000 evaluated scenarios. Conclusions The RHP was cheaper than the standard of care and more effective due to a reduction in the incidence of patients progressing to dialysis, which is a very expensive treatment and many times inaccessible. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of clinical-management-based prevention strategies for CKD patients.

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Early detection of chronic renal disease: coordinated work between primary and specialized care in an ambulatory renal network of Peru

Cited by 15 publications

References 28 publications

Effectiveness of adherence to a renal health program in a health network in Peru

Effectiveness of adherence to a renal health program in a health network in Peru

Cost-Effectiveness Analysis of A Program to Delay Progression to Dialysis and Death Among CKD Patients in Lima, Peru

Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru

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