Projecting the Epidemiological and Economic Impact of Chronic Kidney Disease Using Patient-Level Microsimulation Modelling: Rationale and Methods of Inside CKD

Abstract

Introduction: Chronic kidney disease (CKD) is a serious condition associated with significant morbidity and healthcare costs. Despite this, early-stage CKD is often undiagnosed, and globally there is substantial variation in the effectiveness of screening and subsequent management. Microsimulations can estimate future epidemiological costs, providing useful insights for clinicians, policymakers and researchers. Inside CKD is a programme designed to analyse the projected prevalence and burden of CKD for countries across the world, and to simulate hypothetical intervention strategies that can then be assessed for potential impact on health and economic outcomes at a national and a global level.

Methods: Inside CKD uses a population-based approach that creates virtual individuals for a given country, with this simulated population progressing through a microsimulation in 1-year increments. A series of data inputs derived from national statistics and key literature defined the likelihood of a change in health state for each individual. Input modules allow for the input of nationally specific demographic and CKD status (including prevalence, diagnosis rates, disease stage and likelihood of renal replacement therapy), disease progression, critical comorbidities, and mortality. Health economics are reflected in cost data and a flexible intervention module allows for the testing of hypothetical policies-such as screening strategies-that may alter disease progression and outcomes.

Results: Using input data from the UK as a case study and a 6-year simulation period, Inside CKD estimated a prevalence of 9.2 million individuals (both diagnosed and estimated undiagnosed) with CKD by 2027 and a 5.0% increase in costs for diagnosed CKD and renal replacement therapy. External validation and sensitivity analyses confirmed the observed trends, substantiating the robustness of the microsimulation.

Conclusions: Using a microsimulation approach, Inside CKD extends the reach of current CKD policy analyses by factoring in multiple inputs that reflect national healthcare systems and enable analysis of the effect of multiple hypothetical screening scenarios on disease progression and costs.

Keywords: Burden of disease; Chronic kidney disease; Dialysis; Methodology; Microsimulation; Model; Policy; Prevalence.

Fig. 1

Global reach of the Inside CKD project. CKD chronic kidney disease

Fig. 2

Overview of microsimulation modules. CKD chronic kidney disease, CV cardiovascular, eGFR estimated glomerular filtration rate, ESRD end-stage renal disease, HF heart failure, HTN hypertension, MI myocardial infarction, RRT renal replacement therapy, SGLT2i sodium-glucose cotransporter 2 inhibitor, T2D type 2 diabetes

Fig. 3

Illustrative RRT pathway: people can cycle between different RRT modalities on the basis of eGFR, age and country-specific RRT pathway statistics. Country-specific statistics dictate the probability of transitioning between stages; this diagram is therefore illustrative as each country has its own RRT model. eGFR estimated glomerular filtration rate, RRT renal replacement therapy