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Behaviour modification intervention for patients with chronic kidney disease could provide a mid- to long-term reduction in public health care expenditure: budget impact analysis

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Abstract

Background

A recent cost-effectiveness analysis (CEA) study evaluated the widespread diffusion of behaviour modification intervention for patients with chronic kidney disease (CKD). Incorporating this behaviour modification intervention, comprising educational sessions on nutrition/lifestyle and support for regular patient visits, to the current CKD guideline-based practice was found to be cost-effective. This study aimed to examine the affordability of this efficient new practice under the hypothesis that the behaviour modification intervention would be initiated by general physicians (GPs).

Methods

A budget impact analysis was conducted by defining the target population as patients aged 40–74 years with stage-3–5 CKD based on the prevalence of definitive CKD in the Japanese general population. Costs expended by social insurers without discount were counted as budgets. We estimated the annual budget impact for 15 years by running our CEA model, assuming that it would be good for the span.

Results

We estimated the number of patients with end-stage kidney disease (ESKD) to decrease by 4,496 in the fifteenth year of the new practice using our CEA model. Compared to that in the current practice, the budget impact as total additional expenditure of the new practice was estimated to be negative by the tenth year in the base case.

Conclusions

The widespread diffusion of behaviour modification intervention would contain public health care expenditure over the mid-to-long term, resulting from a reduction in progression to ESKD. We suggest that providing sufficient economic incentives to GPs and strengthening recommendations in CKD guidelines would realise effective GP-initiated interventions.

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Data availability

All data generated or analysed during this study are included in this published article.

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Acknowledgements

We wish to express our thanks to the doctors and dieticians who participated in this study. We are also grateful for the continuous support from the members of the Japanese Society of Nephrology, the Japan Dietetic Association, and the Japanese Medical Association.

Funding

This work was supported by a Grant for a strategic outcome study project from the Ministry of Health, Labour and Welfare of Japan. This work was also supported in part by a Grant-in-Aid for Research on Advanced Chronic Kidney Disease (REACH-J), Practical Research Project for Renal Diseases, Japan Agency for Medical Research and Development, AMED (Grant number JP20ek0310005). This work was also supported by a Grant-in-Aid for Scientific Research (B) (Grant number 19H03865) in Japan.

Author information

Authors and Affiliations

  1. Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8577, Japan

    Reiko Okubo, Masahide Kondo & Shu-Ling Hoshi

  2. Department of Clinical Laboratory Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan

    Reiko Okubo

  3. Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Reiko Okubo, Hirayasu Kai, Chie Saito & Kunihiro Yamagata

  4. Okinawa Heart and Renal Association (OHRA), Naha, Okinawa, Japan

    Kunitoshi Iseki & Chiho Iseki

  5. Tokyo-Kita Medical Center, Kita-Ward, Tokyo, Japan

    Tsuyoshi Watanabe

  6. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan

    Ichiei Narita

  7. Nagoya University, Nagoya, Aichi, Japan

    Seiichi Matsuo

  8. Okayama University, Okayama, Japan

    Hirofumi Makino

  9. Yaizu City Hospital, Yaizu, Shizuoka, Japan

    Akira Hishida

Authors
  1. Reiko Okubo
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  2. Masahide Kondo
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  3. Shu-Ling Hoshi
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  4. Hirayasu Kai
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  5. Chie Saito
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  6. Kunitoshi Iseki
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  7. Chiho Iseki
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  8. Tsuyoshi Watanabe
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  9. Ichiei Narita
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  10. Seiichi Matsuo
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  11. Hirofumi Makino
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  12. Akira Hishida
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  13. Kunihiro Yamagata
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Contributions

Research idea and study design: RO and MK; data acquisition: RO, SH, and MK; data analysis/interpretation: RO, SH, and MK; writing—original drafts: RO; writing—review and editing: MK, SH, HK, CS, KI, CI, TW, IN, SM, HM, AH, and KY.

Corresponding author

Correspondence to Masahide Kondo.

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The authors have declared that no conflict of interest exists.

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Ethics approval was not required, because we only used published studies or secondary data.

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Cite this article

Okubo, R., Kondo, M., Hoshi, SL. et al. Behaviour modification intervention for patients with chronic kidney disease could provide a mid- to long-term reduction in public health care expenditure: budget impact analysis. Clin Exp Nephrol 26, 601–611 (2022). https://doi.org/10.1007/s10157-022-02185-1

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  • DOI: https://doi.org/10.1007/s10157-022-02185-1

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