RT Journal Article
SR Electronic
T1 Cost-Effectiveness Analysis of a Randomized Trial Comparing Care Models for Chronic Kidney Disease
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP 1248
OP 1257
DO 10.2215/CJN.07180810
VO 6
IS 6
A1 Hopkins, Robert B.
A1 Garg, Amit X.
A1 Levin, Adeera
A1 Molzahn, Anita
A1 Rigatto, Claudio
A1 Singer, Joel
A1 Soltys, George
A1 Soroka, Steven
A1 Parfrey, Patrick S.
A1 Barrett, Brendan J.
A1 Goeree, Ron
YR 2011
UL http://cjasn.asnjournals.org/content/6/6/1248.abstract
AB Background and objectives Potential cost and effectiveness of a nephrologist/nurse–based multifaceted intervention for stage 3 to 4 chronic kidney disease are not known. This study examines the cost-effectiveness of a chronic disease management model for chronic kidney disease. Design, setting, participants, & measurements Cost and cost-effectiveness were prospectively gathered alongside a multicenter trial. The Canadian Prevention of Renal and Cardiovascular Endpoints Trial (CanPREVENT) randomized 236 patients to receive usual care (controls) and another 238 patients to multifaceted nurse/nephrologist–supported care that targeted factors associated with development of kidney and cardiovascular disease (intervention). Cost and outcomes over 2 years were examined to determine the incremental cost-effectiveness of the intervention. Base-case analysis included disease-related costs, and sensitivity analysis included all costs. Results Consideration of all costs produced statistically significant differences. A lower number of days in hospital explained most of the cost difference. For both base-case and sensitivity analyses with all costs included, the intervention group required fewer resources and had higher quality of life. The direction of the results was unchanged to inclusion of various types of costs, consideration of payer or societal perspective, changes to the discount rate, and levels of GFR. Conclusions The nephrologist/nurse–based multifaceted intervention represents good value for money because it reduces costs without reducing quality of life for patients with chronic kidney disease.