Abstract: TH-PO542

Cost-Effectiveness of a Multiple Intervention Model for Management of CKD in Primary Health-Care

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Ayala cortes, Rafael Adalid, Unidad de Investigación Médica en Enfermedades Renales, Guadalajara, Jalisco, Mexico
  • Cortes-Sanabria, Laura, Unidad de Investigación Medica en Enfermedades Renales, IMSS, Guadalajara, Jalisco, Mexico
  • Cueto-Manzano, Alfonso M., Unidad de Investigación Medica en Enfermedades Renales, IMSS, Guadalajara, Jalisco, Mexico
  • Rojas-Campos, Enrique, Unidad de Investigación Medica en Enfermedades Renales, IMSS, Guadalajara, Jalisco, Mexico
Background

Strategies to prevent and delay progression of early CKD are urgently needed; however, there is little information about costs and outcomes at the primary health-care. Objective: To evaluate cost-effectiveness of multiple intervention model (MIM) vs conventional health-care model (CHCM) for CKD diagnosis and treatment.

Methods

Prospective evaluation from the health-care provider perspective, performed in 2 Family Medicine Units of Guadalajara, Mexico: MIM and CHCM were evaluated in one unit each. Three phases evaluated: Educative intervention for health professionals, Screening of CKD, and Management/Follow-up of CKD patients. All resources were identified, quantified and recorded; official lists for drugs, medical materials and services, and laboratory/image tests were employed for costs calculation. Only direct medical costs (in USD) were considered. Main outcome and measures: Total cost, average cost per person, and incremental cost-effectiveness ratio (ICER) with bootstrap analysis were determined in each phase. Clinical competence of health professionals was measured with a validated questionnaire, and CKD progression was defined as decline in GFR category.

Results

Clinical competence was not different between models neither at baseline (MIM 63±21 vs CHCM 60±19, p=0.52) nor at final (MIM 94±14 vs CHCM 89±17, p=0.76) evaluations. Average cost per health professional receiving educative intervention in MIM was $833 (CI95% 762-899) vs $901 (819-976) in CHCM (p=0.26). ICER was $22.6 favoring MIM. CKD stages 1-3 were present in 30% of patients from MIM (N 336) and 32% from CHCM (N 454). Average cost per person of CKD screening was $45 (CI95% 41-47) in MIM and $42 (CI95% 37-45) in CHCM (p=0.60). ICER was $2.3 favoring CHCM. For Management/Follow-up phase, 57 patients with CKD stages 1-3 were studied during 12-month in MIM and 58 patients in CHCM. CKD progression was observed in 16% of patients in MIM vs 28% in CHCM (p=0.09). Average cost per patient was $826 (CI95% 760-900) in MIM vs $701 (CI95% 632-777) in CHCM. ICER was dominant in MIM.

Conclusion

MIM are more cost-effective than CHCM to delay kidney disease progression when strategies combining educative interventions for health professionals, screening and adequate management of early CKD are employed at the primary health care.