1. A Cost-Minimization Analysis of Nurse-Led Virtual Case Management in Late-Stage CKD
- Author
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Paul Komenda, Reid Whitlock, Claudio Rigatto, Thomas W. Ferguson, Michelle Di Nella, Drew Hager, and Navdeep Tangri
- Subjects
medicine.medical_specialty ,Cost effectiveness ,medicine.medical_treatment ,030232 urology & nephrology ,Psychological intervention ,030204 cardiovascular system & hematology ,Discount points ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,Intervention (counseling) ,CKD ,medicine ,case management ,home monitoring ,cost-effectiveness ,Dialysis ,KFRE ,business.industry ,medicine.disease ,Blood pressure ,Nephrology ,Cost-minimization analysis ,Emergency medicine ,dialysis ,business ,Kidney disease - Abstract
Introduction Interventions are needed to improve early detection of indications for dialysis before development of severe symptoms or complications. This may reduce suboptimal dialysis starts, prevent hospitalizations, and decrease costs. Our objectives were to explore assumptions around a nurse-led virtual case management intervention for patients with late-stage chronic kidney disease (CKD) with a 2-year Kidney Failure Risk Equation (KFRE) estimated risk of kidney failure ≥80% and to estimate how these assumptions affect potential cost savings. Methods We performed a cost-minimization analysis by developing a decision analytic microsimulation model constructed from the perspective of the health payer. Our primary outcome was the break-even point, defined as the maximum amount a health payer could spend on the intervention without incurring any net financial loss or gain. The intervention group received remote telemonitoring, including daily measurement of several health metrics (blood pressure, oxygen saturation, and weight), and a validated symptom questionnaire accompanied by nurse-led case management, whereas the comparator group received usual care. We assumed patients received the intervention for a maximum of 2 years. Results The break-even point was $7339 per late-stage CKD patient enrolled in the intervention. Based on the distribution of time receiving the intervention, we determined a maximum monthly intervention cost of $703.37. In probabilistic sensitivity analyses, we found that 75% of simulations produced break-even points between $3929 and $9460. Conclusion Nurse-led virtual home monitoring interventions in patients with CKD at high risk of kidney failure have the potential for significant cost savings from the perspective of the health payer., Graphical abstract
- Published
- 2020
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