Coordination of care designed to slow the progression of kidney disease is likely to be cost effective because it prevents the need for dialysis, according to a study presented at ASN Kidney Week 2016 November 15–20 in Chicago.
End-stage renal disease, accounts for 5.6% of total Medicare expenditures, though ESRD patients on dialysis make up only 1.6% of its beneficiaries. Multi-disciplinary care (MDC)—or coordination of care among different clinicians and specialists—has been proposed as a way to benefit patients while reducing costs as they progress from chronic kidney disease to ESRD.
To evaluate this approach, Eugene Lin, MD, from Stanford University, and his colleagues developed a model related to the progression from CKD to ESRD that takes into account different patient characteristics.
Researchers developed a Markov model of progressing from CKD to ESRD that captures patient heterogeneity, assuming that CKD progression depended on age, gender, CKD stage, and level of albuminuria. The researchers calibrated progression probabilities to published data on risks of death and of developing ESRD. Using data from a recent systematic review, the model assumes that multi-disciplinary care decreased mortality rates by 15% and progression rates to ESRD by 55%. Researchers modeled a typical multi-disciplinary care program which involved four nurse practitioner visits per year and obtained ESRD mortality rates and costs from the United States Renal Data System. Sensitivity analyses focused on potentially lower efficiency and higher costs of MDC and on clinical characteristics of the target CKD population
The team found that multi-disciplinary care in patients with CKD is a relatively inexpensive intervention, costing only $24,613 per quality-adjusted life year (QALY). In contrast, a recent analysis found that dialysis costs $129,090 per QALY.
“Even if the multi-disciplinary care program were deployed inefficiently, it would be significantly cheaper than other interventions, largely because it alleviates the much larger cost of dialysis,” said Lin. Medicare coverage of multi-disciplinary care would be a relatively low-cost way to improve the health of patients with kidney disease.
“Our research suggests that strategies aimed at slowing the progression of kidney disease are likely to be cost effective because they prevent the need for dialysis, a very expensive therapy.”
Study: “Multi-Disciplinary Care is Cost-Effective in Chronic Kidney Disease” (Abstract 1362)