A Review of the Costs and Cost Effectiveness of Interventions in Chronic Kidney Disease

Abstract

Given rising healthcare costs and a growing population of patients with chronic kidney disease (CKD), there is an urgent need to identify health interventions that provide good value for money. For this review, the English-language literature was searched for studies of interventions in CKD reporting an original incremental cost-utility (cost per QALY) or cost-effectiveness (cost per life-year) ratio. Published cost studies that did not report cost-effectiveness or cost-utility ratios were also reviewed. League tables were then created for both cost-utility and cost-effectiveness ratios to assess interventions in patients with stage 1-4 CKD, waitlist and transplant patients and those with end-stage renal disease (ESRD). In addition, the percentage of cost-saving or dominant interventions (those that save money and improve health) was compared across these three disease categories. A total of 84 studies were included, contributing 72 cost-utility ratios, 20 cost-effectiveness ratios and 42 other cost measures. Many of the interventions were dominant over the comparator, indicating better health outcomes and lower costs. For the three disease categories, the greatest number of dominant or cost-saving interventions was reported for stage 1-4 CKD patients, followed by waitlist and transplant recipients and those with ESRD (91%, 87% and 55% of studies reporting a dominant or cost-saving intervention, respectively). There is evidence of opportunities to lower costs in the treatment of patients with CKD, while either improving or maintaining the quality of care. In order to realize these cost savings, efforts will be required to promote and effectively implement changes in treatment practices.

Evaluation of cardiovascular disease burden and therapeutic goal attainment in US adults with chronic kidney disease: an analysis of national health and nutritional examination survey data, 2001–2010

“…An analysis of 13,796 patients with CKD and their matched controls from a large health-maintenance organization demonstrated that the presence of CKD-related comorbidities such as CHD and diabetes almost doubled the total cost of care in these cohorts, and the costs associated with these comorbidities were disproportionally higher in patients with concomitant CKD [47]. A recent review assessing cost effectiveness analyses of a wide range of pharmacological and non-pharmacological interventions for patients with CKD found that a high proportion of the interventions were dominant over the comparator (suggesting both improved outcomes for patients and lower costs for payors), particularly those relating to antihypertensive therapies in patients with CKD Stages 1–4 [48]. …”

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

“…6,7 A recent comprehensive review 8 reported that several pharmacological and nonpharmacological interventions for patients with stages 1-4 CKD were cost-effective. However, those with stage 5 CKD incur substantial costs and these expenses increase with disease progression.…”

Early chronic kidney disease: diagnosis, management and models of care

“…1, 84 These data are generally of low quality, but they provide some support for calorie-controlled diets, 85–88 , physical exercise, 89–91 and smoking cessation 92–94 ; predominantly in diabetic CKD patients. Most CKD patients have comorbidities that are amenable to a systematic approach to prevention and early management, and many patients die from cardiovascular events or other causes before they ever develop ESRD.…”