Global Economic Burden Associated with Chronic Kidney Disease: A Pragmatic Review of Medical Costs for the Inside CKD Research Programme

Abstract

Introduction: Chronic kidney disease (CKD) is a progressive disease of growing prevalence, posing serious concerns for global public health. While the economic burden of CKD is substantial, data on the cost of CKD is limited, despite growing pressures on healthcare systems. In this review, we summarise the available evidence in 31 countries and regions and compile a library of costing methodology and estimates of CKD management and disease-associated complications across 31 countries/regions within the Inside CKD programme.

Methods: We collected country/region-specific CKD costs via a pragmatic rapid literature review of local literature and engagement with local experts. We extracted cost data and definitions from identified sources for CKD stages G3a-5, kidney failure with replacement therapy by modality, covering haemodialysis, peritoneal dialysis, and kidney transplants, and disease-associated complications in local currency, converted to United States dollars (USD) and inflated to 2022.

Results: Annual direct costs associated with CKD management rose by an average factor of 4 in each country/region upon progression from stage G3a to G5. Mean annual costs per patient increased considerably more from early stages versus dialysis (stage G3a, mean: $3060 versus haemodialysis, mean: $57,334; peritoneal dialysis, mean: $49,490); with estimates for annual costs of transplant also substantially higher (incident: $75,326; subsequent: $16,672). The mean annual per patient costs of complications were $18,294 for myocardial infarction, $8463 for heart failure, $10,168 for stroke and $5975 for acute kidney injury. Costing definitions varied widely in granularity and/or definition across all countries/regions.

Conclusion: Globally, CKD carries a significant economic burden, which increases substantially with increasing disease severity. We identified significant gaps in published costs and inconsistent costing definitions. Cost-effective interventions that target primary prevention and disease progression are essential to reduce CKD burden. Our results can be used to guide cost collection and facilitate better comparisons across countries/regions to inform healthcare policy.

Keywords: Chronic kidney disease; Economic burden; Kidney replacement therapy; Policy; Review.

Fig. 1

Considered countries and regions

Fig. 2

Median standardised per patient CKD costs, per annum for (a) CKD health state, (b) complication. Upper and lower bars indicate minimum and maximum values; the line between light and dark blue boxes indicates the median value; the borders of the dark and light blue boxes indicate the interquartile range. Costs are calculated using country specific PPP conversion rates, listed in Table S2. PPP purchasing power parity, CKD chronic kidney disease, GFR glomerular filtration rate

Fig. 3

Country-/region-specific annual per patient CKD management costs by KDIGO GFR stage. Costs are calculated using country-specific PPP conversion rates, listed in Table S2. PPP purchasing power parity, CKD chronic kidney disease, KDIGO Kidney Disease Improving Global Outcomes, GFR glomerular filtration rate

Fig. 4

Country/region specific, annual per patient KRT costs by modality. Costs are calculated using country specific PPP conversion rates, listed in Table S2. PPP purchasing power parity, KRT kidney replacement therapy

Fig. 5

Country-/region-specific annual per patient costs for cardiovascular complications. Costs are calculated using country-specific PPP conversion rates, listed in Table S2. PPP purchasing power parity