FORECASTING THE DIALYSIS BURDEN IN MOROCCO AND THE ECONOMIC VALUE OF EARLY NEPHROPROTECTION : A 2025-2035 MARKOV-BASED MULTISCENARIO PROJECTION (PROMOD STUDY)
Author(s)
Omar Maoujoud, PhD, MD1, Amal Yassine, PhD, MD1, mohammed asserraji, MD2, Intissar Haddiya, PhD, MD3.
1Research team of Pharmacoeconomics & Pharmacoepidemiology, Moroccan Society of health economics (SMEPS), Faculty of Medicine, Mohamed V university, Rabat, Morocco, 2Department of Nephrology, Faculty of medicine, Cadia ayyad University, Cadi Ayyad University, Morocco, 3Department of Nephrology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco., Oujda, Morocco.
1Research team of Pharmacoeconomics & Pharmacoepidemiology, Moroccan Society of health economics (SMEPS), Faculty of Medicine, Mohamed V university, Rabat, Morocco, 2Department of Nephrology, Faculty of medicine, Cadia ayyad University, Cadi Ayyad University, Morocco, 3Department of Nephrology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco., Oujda, Morocco.
OBJECTIVES: Morocco's dialysis population reached 41,953 patients in 2024with negligible transplantation access (<1%), threatening healthcare system sustainability. This study aimed to project dialysis population growth under three epidemiological scenarios and quantify the economic value of implementing a national nephroprotection strategy targeting CKD stages 3-4 from the public payer perspective.
METHODS: A Markov cohort model simulating CKD progression was developed following ISPOR-SMDM Modeling Good Research Practices. Three health states were defined: CKD[1-4], Dialysis, and Death. Transition probabilities: CKD-to-Dialysis 8% (central) vs 5.6% (optimistic with nephroprotection); CKD mortality 4%; Dialysis mortality 12%. Population projections used stock-and-flow methodology: N(t)=N(2024)×(1+r)^t under three scenarios: Pessimistic (10-11% growth, uncontrolled progression); Central (7-8% growth, policy inertia); Optimistic (4-5% growth, nephroprotection with 30% RRR and 60% coverage). RRR derived from SGLT2 inhibitor meta-analysis: CREDENCE 0.66, DAPA-CKD 0.56, EMPA-KIDNEY 0.64 (pooled HR 0.62, Lancet 2022). Annual per-patient dialysis cost: $19,260 (including ESA). Two-way sensitivity analysis tested RRR (20-50%) and coverage (10-100%) variations. ROI calculated as cost-avoidance divided by strategy investment.
RESULTS: Projected 2035 dialysis population: 130,000 (pessimistic), 88,000 (central), 71,000 (optimistic). Nephroprotection would avert 16,564 dialysis initiations cumulatively. Ten-year cost avoidance: $1.92 billion. Annual savings trajectory: $177M (2026) to $320M (2035). Two-way sensitivity: cost avoidance ranged from $0.8B (RRR 20%, coverage 30%) to $8.5B (RRR 50%, coverage 100%). At base-case assumptions (RRR 30%, coverage 60%, strategy cost $1,200/patient/year), ROI reached 2.67. Breakeven threshold: annual strategy cost <$18,000/patient at 60% coverage.
CONCLUSIONS: Early nephroprotection with SGLT2 inhibitors in CKD stages 3-4 generates $1.92 billion in avoided dialysis costs over 10 years with ROI of 2.67. These findings support inclusion of nephroprotective agents in national HTA frameworks and performance-based managed entry agreements to ensure health system sustainability.
METHODS: A Markov cohort model simulating CKD progression was developed following ISPOR-SMDM Modeling Good Research Practices. Three health states were defined: CKD[1-4], Dialysis, and Death. Transition probabilities: CKD-to-Dialysis 8% (central) vs 5.6% (optimistic with nephroprotection); CKD mortality 4%; Dialysis mortality 12%. Population projections used stock-and-flow methodology: N(t)=N(2024)×(1+r)^t under three scenarios: Pessimistic (10-11% growth, uncontrolled progression); Central (7-8% growth, policy inertia); Optimistic (4-5% growth, nephroprotection with 30% RRR and 60% coverage). RRR derived from SGLT2 inhibitor meta-analysis: CREDENCE 0.66, DAPA-CKD 0.56, EMPA-KIDNEY 0.64 (pooled HR 0.62, Lancet 2022). Annual per-patient dialysis cost: $19,260 (including ESA). Two-way sensitivity analysis tested RRR (20-50%) and coverage (10-100%) variations. ROI calculated as cost-avoidance divided by strategy investment.
RESULTS: Projected 2035 dialysis population: 130,000 (pessimistic), 88,000 (central), 71,000 (optimistic). Nephroprotection would avert 16,564 dialysis initiations cumulatively. Ten-year cost avoidance: $1.92 billion. Annual savings trajectory: $177M (2026) to $320M (2035). Two-way sensitivity: cost avoidance ranged from $0.8B (RRR 20%, coverage 30%) to $8.5B (RRR 50%, coverage 100%). At base-case assumptions (RRR 30%, coverage 60%, strategy cost $1,200/patient/year), ROI reached 2.67. Breakeven threshold: annual strategy cost <$18,000/patient at 60% coverage.
CONCLUSIONS: Early nephroprotection with SGLT2 inhibitors in CKD stages 3-4 generates $1.92 billion in avoided dialysis costs over 10 years with ROI of 2.67. These findings support inclusion of nephroprotective agents in national HTA frameworks and performance-based managed entry agreements to ensure health system sustainability.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE191
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), SDC: Urinary/Kidney Disorders