# Cost-effectiveness of a ketoanalogue-supplemented very low-protein diet in CKD

## TL;DR

A ketoanalogue-supplemented low-protein diet for CKD patients delays dialysis and saves money compared to a standard low-protein diet.

## Contribution

This study demonstrates the cost-effectiveness of a vegetarian ketoanalogue-supplemented diet in managing CKD stages 4 and 5.

## Key findings

- s-VLPD improved survival by 0.60 years and increased QALYs by 0.49 compared to LPD.
- s-VLPD saved €34,000 per patient from the NHS perspective and €59,147 from the societal perspective.
- Sensitivity analyses confirmed s-VLPD as a dominant and robust strategy.

## Abstract

Chronic kidney disease (CKD) is a global health concern with significant economic implications, particularly in the management of end-stage renal disease (ESRD), which often requires kidney replacement therapy such as dialysis or transplantation. The rising incidence of ESRD is expected to increase healthcare costs substantially by 2030. Dietary protein restriction is a cornerstone of managing CKD progression, and the use of ketoanalogues in very low-protein diets (VLPD) has shown promise in delaying dialysis initiation. This study evaluates the cost-effectiveness of a vegetarian ketoanalogue-supplemented VLPD (s-VLPD) compared with a low-protein diet (LPD) in patients with CKD stages 4 and 5 in Italy.

A Markov model was developed to simulate the health outcomes and costs for patients with CKD stages 4 or 5, treated with either s-VLPD or LPD. The analysis was conducted from both the Italian National Healthcare Service (NHS) and societal perspectives. Healthcare costs considered were: ketoanalogue supplementation, dialysis and diet monitoring. Overall survival and quality-adjusted life years (QALYs) were used as effectiveness outcomes. Sensitivity analyses, including deterministic and probabilistic approaches, assessed the robustness of the results.

The s-VLPD strategy led to improved survival (+0.60 years) and increased QALYs (+0.49) compared with LPD, along with cost savings of approximately €34 000 per patient from the NHS perspective. From the societal perspective, s-VLPD resulted in a cost saving of €59 147 per patient. Sensitivity analyses confirmed that s-VLPD remains a dominant strategy, demonstrating both clinical and economic advantages.

s-VLPD is a cost-effective strategy for managing CKD stages 4 and 5, offering improved patient outcomes and significant cost savings. The findings support the integration of s-VLPD in routine clinical practice, helping delay dialysis initiation, reduce the financial burden on healthcare systems and improve patient quality of life.