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, Intissar Haddiya, MD, PhD2.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I University, Oujda, Morocco, Oujda, Morocco.
1ISPOR Morocco, Research Team of pharmacoeconomics & pharmacoepidemiology, Faculty of Medicine Mohammed V University, Rabat, Morocco, 2Department of Nephrology, Faculty of Medicine, Mohammed I 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 investmen
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: Access to an early nephroprotection 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 investmen
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: Access to an early nephroprotection 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
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE592
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Value of Information
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), Urinary/Kidney Disorders