Cost-effectiveness of protein restricted diets in advanced CKD

Abstract

Background: The dialysis costs are not sustainable everywhere, resulting in many avoidable deaths. Interventions that postpone the start of dialysis can save money and lives. This study evaluates the costs associated with protein-restricted diets in CKD.

Methods: CKD/4-5 patients adhering to protein-restricted diets (PRD) (0.3 g/kg/d, sVLPD; 0.6 g/kg/d, LPD) and controls on free diet were followed for five years, assessing direct and indirect costs. Theoretical and observed analyses compared the estimated and actual costs.

Results: 223 subjects under PRD and 1.248 controls (CON) were studied; 62 PRD adhering to the diet and 123 propensity-matched CON entered the analyses. In PRD and CON, median survival to ESKD was 48.6 (CI:33.8-72) and 28.8 (CI:25-41.7) months (p = 0.017), and median survival to death was 107 (CI:96.2-114.5) and 86.6 (CI:66.3-103.8) months (p = 0.004). The monthly costs per patient were 383 euros for CON, 507 for LPD (+32%), and 767 for sVLPD (+100%); dialysis costs were 4.150 euros (+980%, +720%, +440% vs. CON, LPD, sVLPD). By the theoretical model, the individual costs of PRD vs CON were higher in the short follow-up (8,255 vs 4 595€/year, +80%), but lower in the long follow-up (8,257 vs 23 048€/year, -64%). At the observed model, which comprises both ESKD and deaths, the costs of PRD were lower either in the short (14,754 vs 21 208€/year, -30%), or in the long follow-up (21,764 vs 30 089€/year, -28%).

Conclusions: In patients adherent to diet prescription, low-protein diets delay the start of dialysis, improve survival, and save money.

Keywords: adherence; chronic kidney disease; cost-effectiveness; costs; foods for special medical purpose – FSMP; low-protein diet; nutrition; protein-free products.