Economic Evaluation of System-Wide Implementation of Kidney Supportive Care

This evaluation explored the economic value of kidney supportive care (KSC) in patients with end-stage kidney disease (ESKD) receiving dialysis or conservative management for ESKD in the public health system of New South Wales, Australia.

Deidentified patient-level data were extracted from a linked dataset of admitted and nonadmitted patient data, emergency department episodes, and death registrations. Data between 1 July 2015 and 30 June 2019 were compared with usual treatment prior to statewide KSC implementation in the 2015-2016 financial years. A cost-benefit analysis model estimated the current economic value of KSC (1 July 2015 to 30 June 2019) and projected value to 30 June 2030 under different scenarios.

The proportion of all patients with ESKD receiving KSC increased from 5% in 2015 to 2016 (n = 443) to 16% by 2018 to 2019. Over this period, KSC was estimated to increase survival by 3 to 21 weeks, depending on patient characteristics. Projections showed that continued delivery of KSC, with ESKD treatment modality patterns and costs remaining stable, would deliver a net economic benefit of A$ 109 million through avoided costs of care and return on investment (ROI) of 212%. When adjusted to include survival improvements attributable to KSC, the net economic benefit increased to A$ 275 million (ROI: 535%).

Economic evaluation of the statewide KSC service showed survival benefits and a net economic benefit 4 years after implementation. Net economic value over 10 years was estimated at A$ 275 million, which would increase with greater participation of patients with ESKD suitable for KSC.