TY - JOUR
T1 - Cost-Effectiveness of Clinical Decision Support to Improve CKD Outcomes Among First Nations Australians
AU - Chen, Winnie
AU - Howard, Kirsten
AU - Gorham, Gillian
AU - Abeyaratne, Asanga
AU - Zhao, Yuejen
AU - Adegboye, Oyelola
AU - Kangaharan, Nadarajah
AU - Taylor, Sean
AU - Maple-Brown, Louise J.
AU - Heard, Samuel
AU - Talukder, Mohammad Radwanur
AU - Baghbanian, Abdolvahab
AU - Majoni, Sandawana William
AU - Cass, Alan
AU - Territory Kidney Care Steering Committee
AU - Lloyd, Ali
AU - Bell, Andrew
AU - Connors, Christine
AU - Castillon, Craig
AU - McGuiness, David
AU - Kennedy, Emma
AU - Jobst, Jenny
AU - Moore, Liz
AU - Shorthouse, Molly
AU - Garrawurra, Nathan
AU - Rosas, Nathan
AU - George, Pratish
AU - Nair, Rama
AU - Bond, Rebecca
AU - Forbes, Robert
AU - Ogilvie, Ronald
AU - Daroch, Satpinder
AU - King, Velma
PY - 2025/2
Y1 - 2025/2
N2 - Introduction: The Northern Territory (NT) is a hotspot for chronic kidney disease (CKD) and has a high incidence of kidney replacement therapy (KRT). The Territory Kidney Care clinical decision support (CDS) tool aims to improve diagnosis and management of CKD in remote NT, particularly among First Nations Australians. We model the cost-effectiveness of the CDS versus usual care. Methods: Taking a health care funder perspective, we modeled a cohort of people from remote NT at risk of or with CKD, as of January 1, 2017. A Markov cohort model was developed using 6 years of observed patient-level data (2017–2023), extrapolated to a 15-year time horizon. The CDS tool was modeled to improve CKD diagnosis (scenario 1), improve management (scenario 2), or improve both diagnosis and management (scenario 3). Results: The remote NT cohort consisted of 23,195 people, predominantly (89%) First Nations, with a mean age of 42 years. Scenario 3 (improved diagnosis and management) was most cost-effective at an incremental cost-effectiveness ratio (ICER) of $96,684 per patient avoiding KRT, $30,086 per patient avoiding death. Scenario 1 (improved diagnosis) was less cost-effective, and scenario 2 (improved management) was the least cost-effective. The ICER per quality-adjusted life years (QALYs) gained ranged from $3427 (scenario 3) to $63,486 (scenario 2). Conclusion: Territory Kidney Care is highly cost-effective when it supports early diagnosis of CKD and increases optimal management in diagnosed patients. These results support investing in CDS tools, implemented in strong partnerships, to improve outcomes in settings with a high burden of CKD.
AB - Introduction: The Northern Territory (NT) is a hotspot for chronic kidney disease (CKD) and has a high incidence of kidney replacement therapy (KRT). The Territory Kidney Care clinical decision support (CDS) tool aims to improve diagnosis and management of CKD in remote NT, particularly among First Nations Australians. We model the cost-effectiveness of the CDS versus usual care. Methods: Taking a health care funder perspective, we modeled a cohort of people from remote NT at risk of or with CKD, as of January 1, 2017. A Markov cohort model was developed using 6 years of observed patient-level data (2017–2023), extrapolated to a 15-year time horizon. The CDS tool was modeled to improve CKD diagnosis (scenario 1), improve management (scenario 2), or improve both diagnosis and management (scenario 3). Results: The remote NT cohort consisted of 23,195 people, predominantly (89%) First Nations, with a mean age of 42 years. Scenario 3 (improved diagnosis and management) was most cost-effective at an incremental cost-effectiveness ratio (ICER) of $96,684 per patient avoiding KRT, $30,086 per patient avoiding death. Scenario 1 (improved diagnosis) was less cost-effective, and scenario 2 (improved management) was the least cost-effective. The ICER per quality-adjusted life years (QALYs) gained ranged from $3427 (scenario 3) to $63,486 (scenario 2). Conclusion: Territory Kidney Care is highly cost-effective when it supports early diagnosis of CKD and increases optimal management in diagnosed patients. These results support investing in CDS tools, implemented in strong partnerships, to improve outcomes in settings with a high burden of CKD.
KW - Aboriginal health
KW - chronic kidney disease
KW - clinical decision support
KW - cost
KW - cost-effectiveness
KW - economic evaluation
KW - First Nations
KW - health economics
KW - health informatics
UR - http://www.scopus.com/inward/record.url?scp=85211055888&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1196477
UR - http://purl.org/au-research/grants/NHMRC/1194698
U2 - 10.1016/j.ekir.2024.10.028
DO - 10.1016/j.ekir.2024.10.028
M3 - Article
AN - SCOPUS:85211055888
SN - 2468-0249
VL - 10
SP - 549
EP - 564
JO - Kidney International Reports
JF - Kidney International Reports
IS - 2
ER -
