# Economic Evaluation of Population-Level Chronic Kidney Disease Interventions in the UK National Health Service

## TL;DR

This study evaluates how cost-effective different strategies are for managing chronic kidney disease in the UK, showing that early diagnosis and treatment can save lives and reduce healthcare costs.

## Contribution

The study introduces a population-level Markov model to assess the cost-effectiveness of CKD interventions, including combined approaches.

## Key findings

- Combined interventions prevented 10,351 deaths and gained 48,381 QALYs at £7,675 per QALY in the base case.
- In the constrained scenario, the interventions still showed cost-effectiveness with 10,026 deaths prevented and 47,514 QALYs gained.
- Avoiding progression to dialysis was identified as a key factor in achieving cost savings and improved quality of life.

## Abstract

Background: Chronic kidney disease (CKD) affects 13% of the global population, is predicted to be the fifth leading cause of premature death by 2040, and is associated with increased risk of cardiovascular disease and acute cardiovascular events. With an aging population and rising diabetes rates, the prevalence of CKD is expected to escalate in the United Kingdom, leading to substantial healthcare costs. When patients reach end-stage kidney disease, interventions such as dialysis and transplantation are required. Dialysis is not only extremely costly but is also associated with a diminished quality of life and significantly elevated mortality. Objectives: This study assesses the cost-effectiveness of several population-level interventions designed to manage CKD, including its progression to end-stage kidney disease. Methods: A population-level Markov model was developed to evaluate the cost-effectiveness and population health impacts of 4 key interventions, individually and combined: (1) early/improved diagnosis, (2) enhanced CKD management, (3) increased use of SGLT-2 inhibitors, and (4) higher rates of pre-emptive live donor transplantation. The model incorporates both NHS direct costs and broader economic impacts, with a 10-year horizon and quarterly cycles. Two scenarios were analyzed: a base case (based on disease progression probabilities) and a constrained case (where growth in the number of patients receiving dialysis and transplantation is limited to historical rates observed in the UK National Health Service). Results: All interventions demonstrated cost-effectiveness, with the combined approach preventing 10 351 deaths and yielding 48 381 quality-adjusted life-years (QALYs) at a cost of £7675 per QALY in the base case scenario. In the constrained scenario, the combined interventions demonstrated cost-effectiveness, preventing 10 026 deaths and yielding 47 514 QALYs at a cost of £22 767 per QALY. Conclusions: The results demonstrate the cost-effectiveness of population level interventions for management of CKD, and the significant burden of dialysis, with avoidance of progression to dialysis a key driver of QALY gains and cost offsets.