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A Review of the Costs and Cost Effectiveness of Interventions in Chronic Kidney Disease

Implications for Policy

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Abstract

Given rising healthcare costs and a growing population of patients with chronic kidney disease (CKD), there is an urgent need to identify health interventions that provide good value for money.

For this review, the English-language literature was searched for studies of interventions in CKD reporting an original incremental cost-utility (cost per QALY) or cost-effectiveness (cost per life-year) ratio. Published cost studies that did not report cost-effectiveness or cost-utility ratios were also reviewed. League tables were then created for both cost-utility and cost-effectiveness ratios to assess interventions in patients with stage 1–4 CKD, waitlist and transplant patients and those with end-stage renal disease (ESRD). In addition, the percentage of cost-saving or dominant interventions (those that save money and improve health) was compared across these three disease categories.

A total of 84 studies were included, contributing 72 cost-utility ratios, 20 cost-effectiveness ratios and 42 other cost measures. Many of the interventions were dominant over the comparator, indicating better health outcomes and lower costs. For the three disease categories, the greatest number of dominant or cost-saving interventions was reported for stage 14 CKD patients, followed by waitlist and transplant recipients and those with ESRD (91%, 87% and 55% of studies reporting a dominant or cost-saving intervention, respectively).

There is evidence of opportunities to lower costs in the treatment of patients with CKD, while either improving or maintaining the quality of care. In order to realize these cost savings, efforts will be required to promote and effectively implement changes in treatment practices.

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Acknowledgements

Funding for this study was provided by Amgen. Aside from the participation of Dr Agodoa, the sponsor had no role in study design and concept or manuscript preparation. The publication of this study was not contingent on sponsor approval of the manuscript. Dr Menzin and Ms Lines, Nichols and Rodriguez received funding from the sponsor. Dr Weiner receives research funding from the American Society of Nephrology, Dialysis Clinic, Inc., and Covidien; he previously received funding from Amgen. Dr Neumann received honoraria for his participation in advisory boards sponsored by Amgen and Genzyme. Dr Agodoa is an employee and stockholder of the sponsor. Dr Mayne is an employee of Davita Clinical Research, and was previously an employee and stockholder of Amgen.

Portions of this analysis were presented in preliminary form at the 42nd Annual Meeting and Scientific Exposition of the American Society of Nephrology in San Diego, CA, USA, 29 October 2009.

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Authors and Affiliations

  1. Boston Health Economics, Inc, 20 Fox Rd, Waltham, MA, 02451, USA

    Joseph Menzin, Lisa M. Lines, Christine Nichols & Lauren Rodriguez

  2. Tufts Medical Center, Boston, MA, USA

    Daniel E. Weiner & Peter J. Neumann

  3. Amgen, Thousand, Oaks, CA, USA

    Irene Agodoa

  4. Davita Clinical Research, El Segundo, CA, USA

    Tracy Mayne

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  1. Joseph Menzin
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  2. Lisa M. Lines
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  6. Lauren Rodriguez
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  7. Irene Agodoa
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  8. Tracy Mayne
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Correspondence to Joseph Menzin.

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Menzin, J., Lines, L.M., Weiner, D.E. et al. A Review of the Costs and Cost Effectiveness of Interventions in Chronic Kidney Disease. Pharmacoeconomics 29, 839–861 (2011). https://doi.org/10.2165/11588390-000000000-00000

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