Economic Evaluation of System-Wide Implementation of Kidney Supportive Care

Abstract

Introduction: This evaluation explored the economic value of kidney supportive care (KSC) in patients with end-stage kidney disease (ESKD) receiving dialysis or conservative management for ESKD in the public health system of New South Wales, Australia.

Methods: Deidentified patient-level data were extracted from a linked dataset of admitted and nonadmitted patient data, emergency department episodes, and death registrations. Data between 1 July 2015 and 30 June 2019 were compared with usual treatment prior to statewide KSC implementation in the 2015-2016 financial years. A cost-benefit analysis model estimated the current economic value of KSC (1 July 2015 to 30 June 2019) and projected value to 30 June 2030 under different scenarios.

Results: The proportion of all patients with ESKD receiving KSC increased from 5% in 2015 to 2016 (n = 443) to 16% by 2018 to 2019. Over this period, KSC was estimated to increase survival by 3 to 21 weeks, depending on patient characteristics. Projections showed that continued delivery of KSC, with ESKD treatment modality patterns and costs remaining stable, would deliver a net economic benefit of A$ 109 million through avoided costs of care and return on investment (ROI) of 212%. When adjusted to include survival improvements attributable to KSC, the net economic benefit increased to A$ 275 million (ROI: 535%).

Conclusion: Economic evaluation of the statewide KSC service showed survival benefits and a net economic benefit 4 years after implementation. Net economic value over 10 years was estimated at A$ 275 million, which would increase with greater participation of patients with ESKD suitable for KSC.

Keywords: chronic kidney failure; cost-benefit analysis; kidney supportive care.

Graphical abstract

Figure 1

Age profile of people with end-stage kidney disease in NSW in 2018–2019. NSW, New South Wales.

Figure 2

Prevalent end-stage kidney disease cases (without transplant) over time, by pathway including kidney supportive care (1 July 2015–30 June 2019).

Figure 3

Annual kidney supportive care costs per prevalent end-stage kidney disease case, by pathway and cost type.

Figure 4

Survival differences by cohort estimated by multivariate Cox regression.

Figure 5

Economic impact of expanding kidney supportive care rollout.