Multidisciplinary treatment for patients with chronic kidney disease in pre-dialysis minimizes costs: a four-year retrospective cohort analysis

Abstract Introduction: Chronic kidney disease (CKD) can progress to end-stage renal disease (ESRD), and clinical studies show that this progression can be slowed. The objective of this study was to estimate the costs to Brazil’s public health system (SUS) throughout the course of CKD in the pre-dialysis stage compared to the costs to the SUS of dialysis treatment (DT). Methods: A retrospective cohort study was conducted to analyze clinical and laboratory variables; the outcome analyzed was need for DT. To assess cost, a microcosting survey was conducted according to the Methodological Guidelines for Economic Evaluations in Healthcare and the National Program for Cost Management, both recommended by the Brazilian Ministry of Health for economic studies. Results: A total of 5,689 patients were followed between 2011 and 2014, and 537 met the inclusion criteria. Average costs increased substantially as the disease progressed. The average cost incurred in stage G1 in Brazilian reals was R$ 7,110.78, (US$1,832.06) and in stage G5, it was R$ 26,814.08 (US$6,908.53), accumulated over the four years. Conclusion: A pre-dialysis care program may reduce by R$ 33,023.12 ± 1,676.80 (US$ 8,508.26 ± 432.02) the average cost for each year of DT avoided, which is sufficient to cover the program’s operation, minimizing cost. These results signal to public health policy makers the real possibility of achieving significant cost reduction in the medium term for CKD care (4 years), to a program that disbursed R$ 24 billion (US$ 6.8 billion) for DT in Brazil between 2009 and 2018.

摘要与引言：慢性肾脏病（Chronic Kidney Disease, CKD）可进展为终末期肾病（End-Stage Renal Disease, ESRD），临床研究证实该疾病进程可被延缓。本研究旨在对比慢性肾脏病透析前阶段与透析治疗（Dialysis Treatment, DT）对巴西公共卫生系统（Sistema Único de Saúde, SUS）造成的成本负担。

方法：本研究采用回顾性队列研究设计，分析临床与实验室变量，以透析治疗需求作为研究结局指标。为评估成本，依据巴西卫生部推荐的《医疗经济评价方法学指南》与《国家成本管理计划》开展微成本核算调查。

结果：2011至2014年间，共随访5689例患者，其中537例符合纳入标准。随着疾病进展，平均成本显著升高：四年累计的平均成本在G1期为7110.78巴西雷亚尔（R$7,110.78，合1832.06美元），G5期则达26814.08巴西雷亚尔（R$26,814.08，合6908.53美元）。

结论：透析前护理方案每避免一年透析治疗，可平均节省33023.12±1676.80巴西雷亚尔（合8508.26±432.02美元），该节省额度足以覆盖方案运营成本，实现成本最小化。本研究结果提示公共卫生政策制定者，在中期（4年）内实现慢性肾脏病照护成本显著降低具备现实可行性——2009至2018年间，巴西在透析治疗上的支出达240亿巴西雷亚尔（合68亿美元）。