Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Ren Nutr. 2021 Sep;31(5):484-493. doi: 10.1053/j.jrn.2020.12.008. Epub 2021 Mar 18.
Chronic kidney disease (CKD) is a significant public health problem. An advanced, or innovative, CKD care system of clinical practice collaboration among general physicians (GPs), nephrologists, and other healthcare workers achieved behavior modification in patients with Stage 3 CKD in the Frontier of Renal Outcome Modifications in Japan (FROM-J) study. This behavior modification intervention consisted of educational sessions on nutrition and lifestyle, as well as encouragement of patients' regular visits. The intervention contributed to slowing CKD progression. This study aimed to evaluate the cost-effectiveness of the widespread diffusion of the behavior modification intervention proven effective by the FROM-J study.
A cost-effectiveness analysis was carried out to compare the behavior modification intervention with the current practice recommended by the latest CKD clinical guidelines for GPs. A Markov model with a societal perspective under Japan's health system was constructed. We assumed that the behavior modification intervention proven effective by the FROM-J study would be initiated by GPs for targeted patient cohorts-patients aged 40-74 years with Stage 3 CKD-as a part of the innovative CKD care system.
The incremental cost-effectiveness ratio for the behavior modification intervention compared with current guideline-based practice was calculated as 145,593 Japanese yen (¥; $1,324 United States dollars [$]) per quality-adjusted life year (QALY).
Using the suggested value of social willingness to pay for a one-QALY gain in Japan of ¥5 million (US$45,455) as the threshold to judge cost-effectiveness, the behavior modification intervention is cost-effective. Our results suggest that diffusing the behavior modification intervention proven effective by the FROM-J study could be justifiable as an efficient use of finite healthcare resources. GPs could be encouraged to initiate this intervention by revising the National Health Insurance fee schedule and strengthening clinical guidelines regarding behavior modification interventions.
慢性肾脏病（CKD）是一个重大的公共卫生问题。在日本肾脏预后改良前沿（FROM-J）研究中，普通内科医生（GP）、肾病专家和其他医疗保健工作者之间开展了一种先进或创新的 CKD 临床实践协作护理模式，使 3 期 CKD 患者的行为发生了改变。这种行为改变干预包括营养和生活方式教育课程，以及鼓励患者定期就诊。干预措施有助于减缓 CKD 进展。本研究旨在评估 FROM-J 研究证明有效的行为改变干预措施广泛传播的成本效益。
进行了一项成本效益分析，以比较行为改变干预措施与 GP 最新 CKD 临床指南推荐的现行实践。构建了一个具有社会视角的、基于日本卫生系统的 Markov 模型。我们假设，FROM-J 研究证明有效的行为改变干预措施将由 GP 为目标患者群体（年龄在 40-74 岁、患有 3 期 CKD 的患者）启动，作为创新 CKD 护理系统的一部分。
与现行基于指南的实践相比，行为改变干预措施的增量成本效益比为 145593 日元（¥；1324 美元 [$]）/质量调整生命年（QALY）。
使用日本社会对每获得一个 QALY 的支付意愿价值 500 万日元（US$45455）作为判断成本效益的阈值，行为改变干预措施具有成本效益。我们的研究结果表明，推广 FROM-J 研究证明有效的行为改变干预措施可以作为对有限医疗资源的有效利用。可以通过修改国民健康保险费用表和加强行为改变干预措施的临床指南来鼓励 GP 启动这一干预措施。
