A Cost-Minimization Analysis of Nurse-Led Virtual Case Management in Late-Stage CKD

Abstract

Introduction: Interventions are needed to improve early detection of indications for dialysis before development of severe symptoms or complications. This may reduce suboptimal dialysis starts, prevent hospitalizations, and decrease costs. Our objectives were to explore assumptions around a nurse-led virtual case management intervention for patients with late-stage chronic kidney disease (CKD) with a 2-year Kidney Failure Risk Equation (KFRE) estimated risk of kidney failure $80% and to estimate how these assumptions affect potential cost savings. Methods: We performed a cost-minimization analysis by developing a decision analytic microsimulation model constructed from the perspective of the health payer. Our primary outcome was the break-even point, defined as the maximum amount a health payer could spend on the intervention without incurring any net financial loss or gain. The intervention group received remote telemonitoring, including daily measurement of several health metrics (blood pressure, oxygen saturation, and weight), and a validated symptom questionnaire accompanied by nurse-led case management, whereas the comparator group received usual care. We assumed patients received the intervention for a maximum of 2 years. Results: The break-even point was $7339 per late-stage CKD patient enrolled in the intervention. Based on the distribution of time receiving the intervention, we determined a maximum monthly intervention cost of $703.37. In probabilistic sensitivity analyses, we found that 75% of simulations produced break-even points between $3929 and $9460. Conclusion: Nurse-led virtual home monitoring interventions in patients with CKD at high risk of kidney failure have the potential for significant cost savings from the perspective of the health payer.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses

“…Health Care Cost Savings. Several studies evaluated the effectiveness of telehealth-assisted CM on costs (Dehmer et al, 2018;Ferguson et al, 2020;Fischer et al, 2012;Padwal et al, 2019). According to Dehmer et al (2018), the total health care costs for telemonitoring HTN patients were estimated to be about $281 lower than that for usual care per person.…”

Bibliometric and visual analyses of advancements in chronic kidney disease management

“…During this phase, topics focused on patient self-management, case management, telemedicine, and primary healthcare formed new clusters. [27,28] With improvements in public education and disease awareness, a better quality of life requirement was proposed, and methods for managing chronic diseases were particularly important during this phase. The traditional medical model, which focuses on disease treatment, has become outdated; the new model for chronic disease management emphasizes a patient's primary role in disease prevention and control.…”

Community-Based Advanced Case Management for Patients with Complex Multimorbidity and High Medical Dependence: A Longitudinal Study

“…Case management is defined as "a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes [6]". The efficacies of nurse-led case management focused on disease management for patients with high levels of medical dependence has already been reported [7][8][9][10][11]. A nurse-led case management program 2 of 12 for hospital-discharged older adults with co-morbidities decreased hospital readmission rates and improved subjective health 12 months after the registration [7].…”

“…In this study, we aimed to evaluate the efficacy of advanced case management for 24 months. Based on earlier research [7][8][9][10][11], we hypothesized that case management focused on disease management will reduce chronically ill patients' hospitalizations and emergency transports due to acute exacerbations, stabilize patients' physical conditions, and ultimately reduce healthcare costs and improve quality of life (QOL).…”