title: Cost-effectiveness analysis of a randomized trial comparing care models for chronic kidney disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors: PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. hopkinr@mcmaster.ca
authors: Robert B
authors: RB
authors: Hopkins
authors: Amit X
authors: AX
authors: Garg
authors: Adeera
authors: A
authors: Levin
authors: Anita
authors: A
authors: Molzahn
authors: Claudio
authors: C
authors: Rigatto
authors: Joel
authors: J
authors: Singer
authors: George
authors: G
authors: Soltys
authors: Steven
authors: S
authors: Soroka
authors: Patrick S
authors: PS
authors: Parfrey
authors: Brendan J
authors: BJ
authors: Barrett
authors: Ron
authors: R
authors: Goeree
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