SCREENING FOR CHRONIC KIDNEY DISEASE AND CONNECTION TO CARE IN A WORKPLACE WELLNESS SETTING- A COST EFFECTIVENESS ANALYSIS
Li Y, Devlin JJ Quest Diagnostics, San Juan Capistrano, CA, USA
OBJECTIVES : Patients with chronic kidney disease (CKD) are often unaware of their condition and therefore do not receive care that could slow or prevent progression. Annual employee wellness events can incorporate a CKD outreach program to help refer those at risk of CKD for appropriate care. This study assessed the potential health and economic benefits of adding a CKD outreach program to employee wellness events. METHODS : Based on estimated glomerular filtration rate (eGFR) results from annual wellness testing, individuals with an eGFR of <60 mL/min/1.73 m2 were invited to participate in the CKD program. Those who had an eGFR of <60 at two consecutive annual wellness events were referred to care, which was expected to include guideline-supported ACE inhibitors. From a payer perspective, we simulated 5-year health outcomes and cost with Markov models for diabetic CKD patients and non-diabetic CKD patients under 2 scenarios: 1 with the CKD program and 1 without it. Model parameters were based on the actual program or taken from peer-reviewed literature and governmental fee schedules. In the base case 50 percent of those invited accepted referral to care. RESULTS : For 1,000 diabetic CKD patients invited to the CKD program, the program would improve health outcomes with a gain of 0.32 quality-adjusted life-years and save $413,752 dollars. Seven cases of end-stage renal disease (ESRD) would be avoided by year 5. If those with CKD were invited without regard to diabetes status, the CKD program would improve health outcomes at an incremental cost-effectiveness ratio of $33,908 per quality-adjusted life-year gained. Beyond 5 years, opportunities to delay ESRD events would increase, thereby improving the potential CKD program cost-savings for all patients. CONCLUSIONS : CKD outreach programs associated with annual wellness events can improve health outcomes for individuals with CKD and could be cost-savings for payers.