Cost-Effectiveness Analysis of A Program to Delay Progression to Dialysis and Death Among CKD Patients in Lima, Peru

Abstract Background. The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients starting dialysis and overall mortality. A previous study found that adhered patients have 58% protection against progression to dialysis compared to non-adhered. Objective. We aim to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. Methods. We use a Markov model of three health stages to simulate for 30 years the cost associated with RHP and usual care, as well as years lived free of dialysis (YL) and Quality Adjusted Life Years (QALY). Costs were estimated from the payer perspective. We conduct a Probabilistic Sensitivity Analysis (PSA) to assess the robustness of our estimates. Results. We found that the RHP is a cost-saving alternative compared to usual care, with a per person difference of $-782.73in costs and 0.04 in QALYs. The Incremental Cost-Effectiveness Ratio (ICER) per QALY is $-21,660. From a PSA, RHP holds cost-saving under 999 out of 1,000 evaluated scenarios. Discussion. Our results show the lifetime economic value of a case-management intervention for CKD patients to delay its progression to dialysis. The RHP is cost-saving compared to usual care, with a negative ICER per QALY robust to different scenarios. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of prevention and early referral strategies in CKD patients.