The cost of implementing UK guidelines for the management of chronic kidney disease.
BACKGROUND
Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases.


METHODS
We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed.


RESULTS
In the first year, a practice of 10,000 would identify 147.5 patients with stages 3-5 CKD over and above those already known. All stages 4-5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline>or=5 ml/min/1.73 m2/year, 1.11 with haemoglobin<11 g/dl and 1.67 with blood pressure>150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was euro 6111; and euro 7836 for nephrology referral. Total costs of euro 17 133 in the first year were increased to euro 29,790 through the effect of creatinine calibration.


CONCLUSIONS
CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10,000 patients managed according to guidelines.
Klebe
Bernhard
B
Department of Renal Medicine, Kent and Canterbury Hospital, East Kent Hospitals NHS Trust, and Computing Laboratory, University of Kent, Canterbury, Kent CT1 3NG, UK.
Irving
Jean
J
Stevens
Paul E
PE
O'Donoghue
Donal J
DJ
de Lusignan
Simon
S
Cooley
Roger
R
Hobbs
Helen
H
Lamb
Edmund J
EJ
John
Ian
I
Middleton
Rachel
R
New
John
J
Farmer
Christopher K T
CK
D000328:Adult; D003198:Computer Simulation; D003695:Delivery of Health Care / Q000191:economics; D005500:Follow-Up Studies; D006284:Health Plan Implementation / Q000191:economics*; D006287:Health Planning Guidelines; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D006113:United Kingdom