Abstract

Chronic Kidney Disease (CKD) is a leading public health problem, with substantial burden and economic implications for healthcare systems, mainly due to renal replacement treatment (RRT) for end-stage kidney disease (ESKD). The aim of this study is to develop a multistate predictive model to estimate the future burden of CKD in Chile, given the high and rising RRT rates, population ageing, and prevalence of comorbidities contributing to CKD. A dynamic stock and flow model was developed to simulate CKD progression in the Chilean population aged 40 years and older, up to the year 2041, adopting the perspective of the Chilean public healthcare system. The model included six states replicating progression of CKD, which was assumed in 1-year cycles and was categorised as slow, medium or fast progression, based on the underlying conditions. We simulated two different treatment scenarios. Only direct costs of treatment were included, and a 3% per year discount rate was applied after the first year. We calibrated the model based on international evidence; the exploration of uncertainty (95% credibility intervals) was undertaken with probabilistic sensitivity analysis. By the year 2041, there is an expected increase in cases of CKD stages 3a to ESKD, ceteris paribus, from 442,265 (95% UI 441,808-442,722) in 2021 to 735,513 (734,455-736,570) individuals. Direct costs of CKD stages 3a to ESKD would rise from 322.4M GBP (321.7-323.1) in 2021 to 1,038.6M GBP (1,035.5-1,041.8) in 2041. A reduction in the progression rates of the disease by the inclusion of SGLT2 inhibitors and pre-dialysis treatment would decrease the number of individuals worsening to stages 5 and ESKD, thus reducing the total costs of CKD by 214.6M GBP in 2041 to 824.0M GBP (822.7-825.3). This model can be a useful tool for healthcare planning, with development of preventive or treatment plans to reduce and delay the progression of the disease and thus the anticipated increase in the healthcare costs of CKD.

Highlights

  • Chronic Kidney Disease (CKD) is a major global public health problem [1,2], with substantial implications for quality of life and economic burden on healthcare systems [3,4]

  • The aim of this study is to develop a multistate predictive model to estimate the future burden of CKD in Chile, given the high and rising replacement treatment (RRT) rates, population ageing, and prevalence of comorbidities contributing to CKD

  • Direct costs of CKD stages 3a to end-stage kidney disease (ESKD) would rise from 322.4M GBP (321.7– 323.1) in 2021 to 1,038.6M GBP (1,035.5–1,041.8) in 2041

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Summary

Introduction

Chronic Kidney Disease (CKD) is a major global public health problem [1,2], with substantial implications for quality of life and economic burden on healthcare systems [3,4]. Among the most important health complications of CKD are the development of cardiovascular disease (CVD) and the progression along the natural history of CKD to end-stage kidney disease (ESKD) and the need for renal replacement treatment (RRT) such as dialysis or renal transplant [11,12]. Chronic Kidney Disease (CKD) is a leading public health problem, with substantial burden and economic implications for healthcare systems, mainly due to renal replacement treatment (RRT) for end-stage kidney disease (ESKD). The aim of this study is to develop a multistate predictive model to estimate the future burden of CKD in Chile, given the high and rising RRT rates, population ageing, and prevalence of comorbidities contributing to CKD

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