title: A review of the costs and cost effectiveness of interventions in chronic kidney disease: implications for policy.
abstract: Given rising healthcare costs and a growing population of patients with chronic kidney disease (CKD), there is an urgent need to identify health interventions that provide good value for money. For this review, the English-language literature was searched for studies of interventions in CKD reporting an original incremental cost-utility (cost per QALY) or cost-effectiveness (cost per life-year) ratio. Published cost studies that did not report cost-effectiveness or cost-utility ratios were also reviewed. League tables were then created for both cost-utility and cost-effectiveness ratios to assess interventions in patients with stage 1-4 CKD, waitlist and transplant patients and those with end-stage renal disease (ESRD). In addition, the percentage of cost-saving or dominant interventions (those that save money and improve health) was compared across these three disease categories. A total of 84 studies were included, contributing 72 cost-utility ratios, 20 cost-effectiveness ratios and 42 other cost measures. Many of the interventions were dominant over the comparator, indicating better health outcomes and lower costs. For the three disease categories, the greatest number of dominant or cost-saving interventions was reported for stage 1-4 CKD patients, followed by waitlist and transplant recipients and those with ESRD (91%, 87% and 55% of studies reporting a dominant or cost-saving intervention, respectively). There is evidence of opportunities to lower costs in the treatment of patients with CKD, while either improving or maintaining the quality of care. In order to realize these cost savings, efforts will be required to promote and effectively implement changes in treatment practices.
authors.affiliation: Boston Health Economics, Inc., Waltham, MA, USA. jmenzin@bhei.com
authors.forename: Joseph
authors.initials: J
authors.lastname: Menzin
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lines
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
authors.forename: Christine
authors.initials: C
authors.lastname: Nichols
authors.forename: Lauren
authors.initials: L
authors.lastname: Rodriguez
authors.forename: Irene
authors.initials: I
authors.lastname: Agodoa
authors.forename: Tracy
authors.initials: T
authors.lastname: Mayne
mesh_terms: D002908:Chronic Disease; D003365:Costs and Cost Analysis; D006291:Health Policy; D006801:Humans; D007674:Kidney Diseases / Q000191:economics / Q000628:therapy; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013222:State Medicine; D006113:United Kingdom