An economic evaluation of pre-dialysis stage of chronic kidney disease

Objective: to review clinical and economic studies on the pre-dialysis stage of chronic kidney disease (CKD) and the cost-effectiveness of medical interventions used to detect CKD and prevent its progression.

Material and methods. Articles were collected from the bibliographic databases PubMed, Cochrane Library and eLibrary for 2010–2020. Keywords for the search: ‘chronic kidney disease (CKD)’, ‘cost-effectiveness’, ‘economic evaluation’, ‘economic burden’, ‘cost’, ‘healthcare’. After the selection and elimination of the repeated articles, we reviewed 36 Russian and foreign studies on the economic burden of CKD and the clinical and economic effectiveness of various medical interventions of the CKD pre-dialysis stage.

Results. We found 21 studies on the economic burden of CKD. A significant part of them (n=6) was performed in the United States.The methodology for assessing the economic burden varied significantly from study to study. Studies on medical interventions at the CKD predialysis stage can be divided into three groups: Group 1 (n=9) – studies on the clinical and economic effectiveness of screening programs; Group 2 (n=3) – studies on the clinical and economic effectiveness of nephroprotectors and other drugs that slow down the course of CKD; and Group 3 (n=3) – studies on the clinical and economic effectiveness of multidisciplinary care. We concluded on the clinical and economic feasibility of most interventions that were used to detect CKD and prevent its progression.

Conclusion. We did not find any scientific data that could currently serve as a justification for the clinical and economic feasibility of CKD control programs in the Russian Federation. At the same time, studies conducted in foreign countries on the screening for CKD and some interventions aimed at slowing the progression of CKD suggest that in the Russian Federation, such approaches can be justified not only clinically, but also economically. It is necessary to conduct domestic research on the clinical and economic feasibility of interventions aimed at identifying and treating CKD at an early stage.

1. Lv J.C., Zhang L.X. Prevalence and disease burden of chronic kidney disease. Adv Exp Med Biol. 2019; 1165: 3–15. https://doi.org/10.1007/978-981-13-8871-2_1.

2. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease 2017. Lancet. 2020; 395 (10225): 709–33. https://doi.org/10.1016/S0140-6736(20)30045-3.

3. Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385 (9963): 117–71. https://doi.org/10.1016/S0140-6736(14)61682-2.

4. Lakman I.A., Khalikova A.A., Korzhenevskiy A.A. The evaluation of effect of various outcomes of kidney transplantation surgery on economic costs under treatment of kidneys chronic disease. Health Care of the Russian Federation. 2018; 62 (2): 60–7 (in Russ.). https://doi.org/10.18821/0044-197X-2018-62-2-60-67.

5. Wyld M.L., Lee C.M., Zhuo X., et al. Cost to government and society of chronic kidney disease stage 1–5: a national cohort study. Intern Med J. 2015; 45 (7): 741–7. https://doi.org/10.1111/imj.12797.

6. Satyavani K., Kothandan H., Jayaraman M., Viswanathan V. Direct costs associated with chronic kidney disease among type 2 diabetic patients in India. Indian J Nephrol. 2014; 24 (3): 141–7. https://doi.org/10.4103/0971-4065.132000.

7. Ozieh M.N., Bishu K.G., Dismuke C.E., Egede L.E. Trends in healthcare expenditure in United States adults with chronic kidney disease: 2002–

8. BMC Health Serv Res. 2017; 17 (1): 368. https://doi.org/10.1186/s12913-017-2303-3.

9. Golestaneh L., Alvarez P.J., Reaven N.L., et al. All-cause costs increase exponentially with increased chronic kidney disease stage. Am J Manag Care. 2017; 23 (10 Suppl.): S163–72.

10. McQueen R.B., Farahbakhshian S., Bell K.F., et al. Economic burden of comorbid chronic kidney disease and diabetes. J Med Econ. 2017; 20 (6): 585–91. https://doi.org/10.1080/13696998.2017.1288127.

11. Lage M.J., Boye K.S., Bae J.P., et al. The association between the severity of chronic kidney disease and medical costs among patients with type 2 diabetes. J Med Econ. 2018; 22 (5): 447–54. https://doi.org/10.1080/13696998.2019.1581208.

12. Vupputuri S., Kimes T.M., Colloway M.O., et al. The economic burden of progressive chronic kidney disease among patients with type 2 diabetes. J Diabetes Complicat. 2014; 28 (1): 10–6. https://doi.org/10.1016/j.jdiacomp.2013.09.014.

13. Manns B., Hummelgarn B., Tonelli M., et al. The cost of care for people with chronic kidney disease. Can J Kidney Dis. 2019; 6: 2054358119835521. https://doi.org/10.1177/2054358119835521.

14. Darbà J., Marsà A. Chronic kidney disease in Spain: analysis of patient characteristics, incidence and direct medical costs (2011–2017). J Med Econ. 2020; 23 (12): 1623–9. https://doi.org/10.1080/13696998.2020.1830782.

15. Nguyen N.T., Cockwel P., Maxwell A.P., et al. Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England. PLoS One. 2018; 13 (11): e0207960. https://doi.org/10.1371/journal.pone.0207960.

16. Low S., Lim S.C., Zhang X., et al. Medical costs associated with chronic kidney disease progression in an Asian population with type 2 diabetes mellitus. Nephrology (Carlton). 2019; 24 (5): 534–41. https://doi.org/10.1111/nep.13478.

17. Lim G.J., Liu Y.L., Low S., et al. Medical costs associated with severity of chronic kidney disease in type 2 diabetes mellitus in Singapore. Ann Acad Med Singap. 2020; 49 (10): 731–41.

18. Goncalves G.M., Silva E.N. Cost of chronic kidney disease attributable to diabetes from the perspective of the Brazilian Unified Health System. PLoS One. 2018; 13 (10): e0203992. https://doi.org/10.1371/journal.pone.0203992.

19. Ahlawat R., Tiwari P., D’Cruz S. Direct cost for treating chronic kidney disease at an outpatient setting of a tertiary hospital: evidence from a cross-sectional study. Value Health Reg Issues. 2017; 12: 36–40. https://doi.org/10.1016/j.vhri.2016.10.003.

20. Turchetti G., Belleli S., Amato M., et al. The social cost of chronic kidney disease in Italy. Eur J Health Econ. 2017; 18 (7): 847–58. https://doi.org/10.1007/s10198-016-0830-1.

21. Kerr M., Bray B., Medcalf J., et al. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant. 2012; 27 (Suppl. 3): iii73–80. https://doi.org/10.1093/ndt/gfs269.

22. Honeycutt A.A., Segel J.E., Zhuo X., et al. Medical costs of CKD in the Medicare population. J Am Soc Nephrol. 2013; 24 (9): 1478–83. https://doi.org/10.1681/ASN.2012040392.

23. Gandjour A., Armsen W., Wehmeyer W., et al. Costs of patients with chronic kidney disease in Germany. PLoS One. 2020; 15 (4): e0231375. https://doi.org/10.1371/journal.pone.0231375.

24. Kim S.H., Jo M.W., Go D.S., et al. Economic burden of chronic kidney disease in Korea using national sample cohort. J Nephrol. 2017; 30 (6): 787–93. https://doi.org/10.1007/s40620-017-0380-3.

25. Oosten M.J., Logtenberg S.J., Leegte M.J., et al. Age-related difference in health care use and costs of patients with chronic kidney disease and matched controls: analysis of Dutch health care claims data. Nephrol Dial Transplant. 2020; 35 (12): 2138–46. https://doi.org/10.1093/ndt/gfz146.

26. Critselis E., Vlahou A., Stel V., Morton R.L. Cost-effectiveness of screening type 2 diabetes patients for chronic kidney disease progression with the CKD273 urinary peptide classifier as compared to urinary albumin excretion. Nephrol Dial Transplant. 2018; 33 (3): 441–9. https://doi.org/10.1093/ndt/gfx068.

27. Good D.M., Zürbig P., Argilés A., et al. Naturally occurring human urinary peptides for use in diagnosis of chronic kidney disease. Mol Cell Proteomics. 2010; 9 (11): 2424–37. https://doi.org/10.1074/mcp.M110.001917.

28. Boersma C., Gansevoort R.T., Pechlivanoglou P., et al. Screenand treat strategies for albuminuria to prevent cardiovascular and renal disease: cost-effectiveness of nationwide and targeted interventions based on analysis of cohort data from the Netherlands. Clin Ther. 2010; 32 (6): 1103–21. https://doi.org/10.1016/j.clinthera.2010.06.013.

29. Howard K., White S., Salkeld G., et al. Cost-effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: a modeled analysis. Value Health. 2010; 13 (2): 196–208. https://doi.org/10.1111/j.1524-4733.2009.00668.x.

30. Kessler R., Keusch G., Szucs T.D., et al. Health economic modelling of the cost-effectiveness of microalbuminuria screening in Switzerland. Swiss Med Wkly. 2012; 142: w13508. https://doi.org/10.4414/smw.2012.13508.

31. Ferguson T.W., Tangro N., Tan Z., et al. Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective. Kidney Int. 2017; 92 (1): 192–200. https://doi.org/10.1016/j.kint.2017.02.022.

32. Manns B., Hemmelgarn B., Tonelli M., et al. Population based screening for chronic kidney disease: cost effectiveness study. BMJ. 2010; 8 (341): c5869. https://doi.org/10.1136/bmj.c5869.

33. Kondo M., Yamagata K., Hoshi S.L., et al. Cost-effectiveness of chronic kidney disease mass screening test in Japan. Clin Exp Nephrol. 2012; 16 (2): 279–91. https://doi.org/10.1007/s10157-011-0567-1.

34. Hoerger T.J., Wittenborn J.S., Segel J.E., et al. A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening. Am J Kidney Dis. 2010; 55 (3): 463–73. https://doi.org/10.1053/j.ajkd.2009.11.017.

35. Go D.S., Kim S.H., Park J., et al. Cost-utility analysis of the National Health Screening Program for chronic kidney disease in Korea. Nephrology (Carlton). 2019; 24 (1): 56–64. https://doi.org/10.1111/nep.13203.

36. Alfie J., Aparicio L.S., Waisman G.D. Current strategies to achieve further cardiac and renal protection through enhanced renin-angiotensin aldosterone system inhibition. Rev Recent Clin Trials. 2011; 6 (2): 134–46. https://doi.org/10.2174/157488711795177912.

37. Vejakama P., Ingsathit A., McKay G.J., et al. Treatment effects of renin-angiotensin aldosterone system blockade on kidney failure and mortality in chronic kidney disease patients. BMC Nephrol. 2017; 18 (1): 342. https://doi.org/10.1186/s12882-017-0753-9.

38. Pattanaprateep O., Ingsathit A., McEvoy M., et al. Cost-effectiveness analysis of renin-angiotensin aldosterone system blockade in progression of chronic kidney disease. Value Health Reg Issues. 2018; 15: 155–60. https://doi.org/10.1016/j.vhri.2017.12.011.

39. Permsuwan U., Dilokthornsakul P., Thavorn K., et al. Cost effectiveness of dipeptidyl peptidase-4 inhibitor monotherapy versus sulfonylurea monotherapy for people with type 2 diabetes and chronic kidney disease in Thailand. J Med Econ. 2017; 20 (2): 171–81. https://doi.org/10.1080/13696998.2016.1238386.

40. Widén J., Ivarsson M., Schalin L., et al. Cost-effectiveness analysis of patiromer in combination with renin-angiotensin-aldosterone system inhibitors for chronic kidney disease in Sweden. Pharmacoeconomics. 2020; 38 (7): 747–64. https://doi.org/10.1007/s40273-020-00902-w.

41. Hwang S.J., Tsai J.C., Chen H.C. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology (Carlton). 2010; 15 (Suppl. 2): 3–9. https://doi.org/10.1111/j.1440-1797.2010.01304.x.

42. Lin E., Chertow G.M., Yan B., et al. Cost-effectiveness of multidisciplinary care in mild to moderate chronic kidney disease in the United States: a modeling study. PLoS Med. 2018; 15 (3): e1002532. https://doi.org/10.1371/journal.pmed.1002532.

43. Wei S.Y., Chang Y.Y., Mau L.W., et al. Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs. Nephrology (Carlton). 2010; 15 (1): 108–15. https://doi.org/10.1111/j.1440-1797.2009.01154.x.

44. Chen P.M., Lai T.S., Chen P.Y., et al. Multidisciplinary care program for advanced chronic kidney disease: reduces renal replacement and medical costs. Am J Med. 2015; 128 (1): 68–76. https://doi.org/10.1016/j.amjmed.2014.07.042.

45. Yagudina R.I., Serpik V.G., Abdrashitova G.T., Kotenko O.N. The economic burden of chronic kidney disease in the Russian Federation. Pharmacoeconomics: Theory and Practice. 2014; 2 (4): 34–9 (in Russ.).

46. Ryazhenov V.V., Gorokhova S.G. Pharmacoeconomic aspects of the treatment of anemia in Russian patients with chronic kidney disease. Clinical Nephrology. 2014; 6: 32–5 (in Russ.).

47. Serpik V.G. Development results of complex pharmacoeconomical model of chronic kidney insufficiency complications treatment. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmako epidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2013; 6 (1): 51 (in Russ.).

48. Yagudina R.I., Kulikov A.Yu., Morozov A.L. Pharmacoeconomic evaluation of treatment anemia with erythropoietic agents in chronic kidney disease patients. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2009; 2 (3): 39–44 (in Russ.).

49. Makeeva Е.R. The chronic kidney disease increases the direct medical costs on treating patients with chronic heart failure. Cardiovascular Therapy and Prevention. 2009; 8 (6 Suppl. 1): 221 (in Russ.).

50. Yagudina R.I., Serpik V.G., Abdrashitova G.T. Pharmacoeconomic analysis of medical care for chronic renal disease patients in need of renal replacement therapy via peritoneal dialysis and hemodialysis in the Russian healthcare environment. Pharmacoeconomics: Theory and Practice. 2015; 3 (3): 103–10 (in Russ.).

51. Yagudina R.I., Shilov E.M., Serpik V.G., Abdrashitova G.T. Methodology for pharmacoeconomic analysis in nephrology. Nephrology (Saint-Petersburg). 2016; 20 (4): 25–30 (in Russ.).

52. Yagudina R.I., Kulikov A.Yu., Serpik V.G., et al. Pharmacoeconomics of chronic kidney disease. The Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products. 2015; 1: 59–62 (in Russ.).

53. Moscow nephrologists have declared 2019 the year of outpatient work. Available at: https://medvestnik.ru/content/news/Nefrologi Moskvy-obyavili-2019-i-godom-ambulatornoi-raboty.html (in Russ.) (accessed 12.08.2021).