Cost implications of caring for chronic kidney disease: are interventions cost-effective?

Recent data suggest a large, rising burden of chronic kidney disease (CKD) in the general population and rising expenses associated with it. In 2007, CKD contributed 27.6% of costs and CKD subjects constituted 9.8% of the population. Between 1993 and 2007, overall Medicare costs nearly doubled and CKD-associated costs increased about 5-fold. The Medicare cost of end-stage renal disease has risen from $12.2 in 2000 to $20.8 billion in 2007. This review examines cost-effectiveness of prevention and treatment of CKD. Mathematical derivation of savings associated with prevention of CKD is not feasible because of dearth of data. However, examination of various factors that would affect such a hypothetical derivation indicates that prevention of CKD is cost-effective. Better data enable modeling of gross savings of slowing the progression of CKD. Data suggest that if at the beginning of the current decade, the rate of decline in GFR decreased by 10% and 30% in every patient with GFR of 60 mL/min/1.73 m(2) or less the gross direct cumulative health care savings over the next 10 years amount to $18.56 and $60.61 billion, respectively. Additional benefits accrue as a result of diminishing disability and gain in productivity. The analysis suggests that prevention and slowing progression of CKD is cost-effective.