Purpose: Patients with chronic kidney disease may not consistently receive optimal care and chronic care models that rely on physicians or nurses that closely track disease progression may be beneficial in reducing the rate of disease progression. This study estimated the cost effectiveness of a chronic disease management model for chronic kidney disease.
Methods: In a multi-centre randomized control trial, the Canadian Prevention of Renal and Cardiovascular Endpoints Trial (CanPREVENT), patients with chronic kidney disease received either usual care or a nurse/nephrologist supported chronic care model that targeted factors associated with development of kidney and cardiovascular disease events. Cost and outcomes from CanPREVENT were compared to determine the incremental cost-effectiveness of the chronic disease management model with probabilistic analysis. Base case analysis included disease-related costs, and sensitivity analysis included all costs recorded for each subject.
Results: 238 patients received the nurse/nephrologist intervention and 236 received the control usual care. Over 2 years, there was a trend towards less disease-related costs in the intervention group (intervention: $4,631, control: $5,741: difference $1,109, P=0.146). All costs were significantly lower in the intervention group (intervention: $11,739, control $14,180, difference $2,441: P=0.023). These differences were mostly related to lower hospitalization costs. In addition, average HUI3 utility score increased by 0.024 in the intervention group, while declining by 0.021 in controls group patients over two years P=0.013. In the base case analysis and with all costs, the intervention dominates the control group. The results are robust to including disease costs only versus all costs, payer versus societal perspective, and to changes in the discount rate.
Conclusions: CanPREVENT was conducted to investigate the feasibility, effectiveness and cost effectiveness of a nephrolgist/nurse based multifaceted intervention for patients with CKD. Based on these economic results, CanPREVENT represents good value for money because it reduces costs and improves outcomes.