Cost-Effectiveness of Clinical Decision Support to Improve CKD Outcomes Among First Nations Australians.

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Tác giả: Asanga Abeyaratne, Oyelola Adegboye, Abdolvahab Baghbanian, Alan Cass, Winnie Chen, Gillian Gorham, Samuel Heard, Kirsten Howard, Nadarajah Kangaharan, Sandawana William Majoni, Louise J Maple-Brown, Mohammad Radwanur Talukder, Sean Taylor, Yuejen Zhao

Ngôn ngữ: eng

Ký hiệu phân loại: 344.043 *Control of disease

Thông tin xuất bản: United States : Kidney international reports , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 674002

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 6,684 per patient avoiding KRT, 0,086 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 427 (scenario 3) to 3,486 (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.
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