Prevention is less expensive than treatment in chronic kidney disease: a descriptive analysis

The prevalence of chronic kidney disease (CKD) is increasing worldwide, leading to great concern regarding costs, particularly in underdeveloped or developing countries. Estimating the costs of different CKD management approaches is necessary for planning public policies.

To evaluate the costs of renal replacement therapy (RRT) and non-RRT treatment and to propose the screening for CKD in the Brazilian Health Care System (SUS).

This descriptive analysis was based on information from the Brazilian Health Ministry database, DATASUS (www.datasus.saude.gov.br), and scheduled payments approved by the SUS, including complementary exams related to CKD screening, diagnosis and treatment, recommended assessments by stages of CKD, and health professionals' salaries.

Values (in US$) of the probable annual costs for CKD since diagnosis, followed by different CKD stages, and the RRT phase are: first evaluation, 5.00; first evaluation of individuals at risk, 12.03; CKD stage 1, 5.00; 2, 7.36; 3, 53.32; 3B, 36.85; 4, 129.51; 5-non dialytic, 183.73; 5D-peritoneal dialysis, 3,539.10; and stage 5D-hemodialysis (7,925.87).

The cost of screening (early diagnosis) for CKD or initial assessment of CKD stage 1 for one patient, including complementary exams and medical appointments, is US$ 5.00 (based on standard SUS reimbursement values). The costs of 1 year of treatment for a single patient with stage 5D CKD on hemodialysis could cover care for 1,584 with stage 1 CKD or 61 patients with stage 4 CKD. Our data indicates a clear economic advantage of early CKD diagnosis for public health.