Paffett Molly, Phannajit Jeerath, Chavarina Kinanti Khansa, Chuanchaiyakul Tanainan, Jiamjariyapon Teerayuth, Thanachayanont Teerawat, Chanpitakkul Methee, Lekagul Salyaveth, Teerawattananon Yot, Tungsanga Kriang
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
Department of Economics and Related Studies (DERS), University of York, Heslington, York, UK.
Kidney Int Rep. 2024 May 21;9(8):2546-2558. doi: 10.1016/j.ekir.2024.05.012. eCollection 2024 Aug.
An integrated care program for chronic kidney disease (CKD) in Thailand has shown its effectiveness in delaying the decline in kidney function, as evidenced by the Effectiveness of Integrated Care on Delaying Progression of Stages 3 to 4 CKD in Rural Communities of Thailand (ESCORT-1) randomized control trial and the ESCORT-2 prospective cohort study. Designed for sustainability within the primary healthcare system, the program optimizes the use of the existing workforce by fostering collaboration among local multidisciplinary care teams (MDCTs) and community care networks (CCNs).
A Markov model with a lifetime horizon was used to conduct a cost-utility analysis from a societal perspective. Individual participant level data from ESCORT studies, national registries, and relevant literature were used to estimate model parameters. A budget impact analysis from the payer's perspective was also assessed over a 5-year period.
The integrated care program yielded a dominant result with 1.84 quality-adjusted life years (QALYs) gained with "less" lifetime cost, resulting in a negative incremental cost-effectiveness ratio (ICER). Probabilistic analysis showed that the intervention being cost-effective almost 100% of the time at the local willingness-to-pay threshold. The intervention maximized cost-effectiveness when delivered as early as possible, both in terms of age and stage. The budget impact analysis estimated that the introduction of the intervention could save about 7% of the Thai government's total health expenditure or 205 billion Thai-Baht ($5.9 billion) over 5 years with cost savings beginning from the third year onwards.
The integrated care program for CKD offers potential benefits and cost savings for patients, caregivers, and payers. Future efforts should focus on the screening and implementation processes across various regions and healthcare settings.
泰国慢性肾脏病（CKD）综合护理项目已证明其在延缓肾功能下降方面的有效性，泰国农村社区3至4期CKD综合护理延缓疾病进展的有效性（ESCORT - 1）随机对照试验和ESCORT - 2前瞻性队列研究证明了这一点。该项目旨在实现初级医疗保健系统内的可持续性，通过促进当地多学科护理团队（MDCT）和社区护理网络（CCN）之间的协作来优化现有劳动力的使用。
采用具有终身视野的马尔可夫模型从社会角度进行成本效用分析。ESCORT研究、国家登记处和相关文献中的个体参与者层面数据用于估计模型参数。还从支付方角度评估了5年期的预算影响分析。
综合护理项目产生了显著效果，获得了1.84个质量调整生命年（QALY），同时“降低了”终身成本，导致增量成本效益比（ICER）为负。概率分析表明，在当地支付意愿阈值下，该干预措施几乎在100%的时间内具有成本效益。无论从年龄还是疾病阶段来看，尽早实施干预可使成本效益最大化。预算影响分析估计，引入该干预措施在5年内可节省约7%的泰国政府卫生总支出，即2050亿泰铢（59亿美元），成本节省从第三年开始。
CKD综合护理项目为患者、护理人员和支付方带来了潜在益处和成本节约。未来的工作应集中在不同地区和医疗环境中的筛查和实施过程。
