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Kidney Week

Abstract: FR-PO251

Cost Analysis of a Virtual Monitoring System to Reduce Suboptimal Initiation of Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Hager, Drew, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Ferguson, Thomas W., Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
  • Nadurak, Stewart, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada

Patients with kidney failure require renal replacement therapy in the form of dialysis or kidney transplant to survive. Optimal initiation of dialysis includes outpatient, elective implementation of a patient’s chosen modality once clinical indications for dialysis are met. Despite interdisciplinary nephrology care teams, suboptimal initiation requiring hospitalization occurs in approximately 30% of patients and is estimated to cost Canadians $33 million per year. Virtual monitoring in high-risk chronic kidney disease (CKD) patients may decrease the rate of suboptimal initiations and therefore decrease hospitalization expenses.The objective of this study is to evaluate the cost savings of a virtual monitoring program in high-risk CKD patients.


We constructed a decision analytic Markov model from the perspective of the Canadian health payer. A virtual monitoring strategy was compared with the status quo. Costs of a suboptimal initiation, CKD multidisciplinary clinic care, and for receiving dialysis were taken from a review of the literature. Probability of kidney failure was calculated based on the Kidney Failure Risk Equation (Tangri et al, JAMA, 2011), and risks of mortality on dialysis and with late stage CKD were taken from national dialysis registries. Effectiveness of the intervention was assumed to be similar to other virtual monitoring interventions in chronic disease patients and evaluated in sensitivity analyses (baseline relative risk reduction (RRR) of a suboptimal dialysis start 0.39).


Compared with the status quo the virtual monitoring system was associated with a cost savings of $762.29 per patient enrolled in the intervention. With threshold analysis we found that the RRR of a suboptimal dialysis start afforded by the intervention would have to be reduced to 0.255 to reach cost neutrality. In univariate sensitivity analyses the most influential variables included the probability of kidney failure per month, the relative risk reduction afforded by the intervention, the hospitalization cost of a suboptimal dialysis initiation, and the proportion of kidney failure starts that are assumed to be suboptimal.


Allocation of funds toward implementation of a virtual monitoring system with the potential to decrease rates of suboptimal dialysis initiation can produce significant cost savings.