OBJECTIVES : Chronic kidney disease (CKD) leads to significant resource burden through the incidence of end-stage renal disease (ESRD) and cardiovascular disease (CVD). With the prevalence of CKD increasing, there is a need for new, cost-effective treatments to alleviate patient and economic burden. The objective of this study was to undertake a systematic literature review (SLR) of economic models to inform the structural design of a cost-effectiveness model for evaluating CKD treatments.

METHODS : An SLR designed according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist was undertaken to identify English-language economic evaluations covering CKD. Electronic databases (MEDLINE, Embase, The Cochrane Library and EconLit) were searched from inception to October 2017. Results were classified into CKD models, diabetes models with nephropathy components, CVD models with CKD components and ESRD models. Only the first two categories were in scope of the current study

RESULTS : The SLR identified 13 CKD models and 48 diabetes models that included nephropathy components.

CKD models typically utilised structures based on pre-defined CKD stages, according to patients estimated glomerular filtration rate (eGFR). Linear rates of eGFR decline adjusted for CKD stage and clinical history (mean annual decline of 2.52 [0.65-5.2] mL/min/1.73m; based on 5 studies), and CKD category transition probabilities (7 studies) were modelled. Five CKD models explicitly modelled CVD, with risks derived from the Framingham Heart Study and combined with CKD-specific hazard ratios.

Amongst diabetes models, health states based on albuminuria severity were most common (32 studies) and typically utilised transition probabilities (33 studies) with CVD risk derived directly from observational studies.

CONCLUSIONS : Previously published economic models utilised frameworks based on eGFR or albuminuria. However, no clear consensus on the most appropriate framework for the modelling of kidney disease could be confirmed.