title: Adding specialized clinics for remote-dwellers with chronic kidney disease: a cost-utility analysis.
abstract: OBJECTIVE
  This study aimed to determine whether opening a new clinic in a remote region would be a cost-effective means of improving care for remote-dwellers with CKD.
  
  
  METHODS
  This study is a cost-utility analysis from a public payer's perspective over a lifetime horizon, using administrative data from a large cohort of adults with stage 3b-4 CKD in Alberta, Canada. The association between the distance from each simulated patient's residence and the practice location of the closest nephrologist and clinical outcomes (quality of care, hospitalization, dialysis, and death) were examined. A Markov 6-month cycle economic decision model was analyzed; estimates of the effect of a new clinic were based on the association between residence location, resource use, and outcomes. Costs are reported in 2009 Canadian dollars.
  
  
  RESULTS
  The costs for equipping and operating a clinic for 321 remote-dwelling patients were estimated at $25,000 and $250,000/yr, respectively. The incremental cost-utility ratios (ICURs) ranged from $4000 to $8000/quality-adjusted life-year under most scenarios. However, if reducing distance to nephrologist care does not alter mortality or hospitalization among remote-dwellers, the cost-effectiveness becomes less attractive. All other one-way sensitivity analyses had negligible effects on the ICUR.
  
  
  CONCLUSIONS
  Given the low costs of equipping and operating new clinics, and the very attractive ICUR relative to other currently funded interventions, establishing new clinics for remote-dwellers could play an important role in efficiently improving outcomes for patients with CKD. High-quality controlled studies are required to confirm this hypothesis.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.forename: Scott W
authors.initials: SW
authors.lastname: Klarenbach
authors.forename: Betty
authors.initials: B
authors.lastname: Chui
authors.forename: Bharati
authors.initials: B
authors.lastname: Ayyalasomayajula
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.forename: Kailash
authors.initials: K
authors.lastname: Jindal
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
mesh_terms: D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D006295:Health Resources / Q000191:economics*; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D009398:Nephrology / Q000191:economics*
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