A simulation model to estimate cost-offsets for a disease-management program for chronic kidney disease

Abstract

Aim: The aim of this paper is to develop a simulation model that analyzes cost-offsets of a hypothetical disease management program (DMP) for patients with chronic kidney disease (CKD) in Germany compared to no such program. Methods: A lifetime Markov model with simulated 65-year-old patients with CKD was developed using published data on costs and health status and simulating the progression to end-stage renal disease (ESRD), cardiovascular disease and death. A statutory health insurance perspective was adopted. Results: This modeling study shows considerable potential for cost-offsets from a DMP for patients with CKD. The potential for cost-offsets increases with relative risk reduction by the DMP and baseline glomerular filtration rate. Results are most sensitive to the cost of dialysis treatment. Conclusion: This paper presents a general ‘prototype’ simulation model for the prevention of ESRD. The model allows for further modification and adaptation in future applications.

Keywords:

• chronic kidney disease
• disease management
• simulation model

Acknowledgement

The authors would like to thank Kathrin Jansen for providing valuable input to an earlier draft of the paper. We also thank Carlo Barbieri and Isabella Cattinelli for critical review of the manuscript. The study was supported by Fresenius Medical Care Deutschland.

Financial & competing interests disclosure

A Gandjour received a grant from Fresenius Medical Care Deutschland for this work. U Tschulena, S Steppan & E Gatti are employees of Fresenius Medical Care Deutschland. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Disease management is considered an important approach in delaying chronic kidney disease progression and ultimately end-stage renal disease.

• Disease management may also reduce the risk for cardiovascular disease that is elevated in chronic kidney disease patients.

• This paper presents a general ‘prototype’ simulation model for the prevention of end-stage renal disease through disease management.

• The model shows considerable potential for cost-offsets and health gains for a disease management program enrolling patients with chronic kidney disease.

• Early enrollment in a management program has a higher potential for cost-offsets than late enrollment.

• Results of our analysis may help to design a management program that has a high potential for being cost–effective.

Notes