The cost of implementing UK guidelines for the management of chronic kidney disease

Klebe, Bernhard and Irving, Jean and Stevens, Paul E. and O'Donoghue, Donal J. and de Lusignan, Simon and Cooley, Roger and Hobbs, Helen and Lamb, Edmund J. and John, Ian and Middleton, Rachel and New, John and Farmer, Chris (2007) The cost of implementing UK guidelines for the management of chronic kidney disease. Nephrology Dialysis Transplantation, 22 (9). pp. 2504-2512. ISSN 0931-0509 . (Full text available)

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Abstract

Background. Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases. Methods. We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed. Results. In the first year, a practice of 10 000 would identify 147.5 patients with stages 3-5 CKD over and above those already known. All stages 4-5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline >= 5 ml/min/ 1.73m(2)/year, 1.11 with haemoglobin < 11 g/dl and 1.67 with blood pressure > 150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was is an element of 6111; and is an element of 7836 for nephrology referral. Total costs of is an element of 17 133 in the first year were increased to is an element of 29 790 through the effect of creatinine calibration. Conclusions. CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10 000 patients managed according to guidelines

Item Type: Article
Uncontrolled keywords: cardiovascular risk; chronic kidney disease; cost analysis; glomerular filtration rate; guidelines; referral
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
Divisions: Faculties > Science Technology and Medical Studies > School of Computing
Depositing User: Maureen Cook
Date Deposited: 25 Apr 2008 10:10
Last Modified: 02 May 2014 13:37
Resource URI: http://kar.kent.ac.uk/id/eprint/2844 (The current URI for this page, for reference purposes)
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