Cost-Effectiveness of Integrated Care in Patients with Chronic Kidney Disease Stage 3 and 4 Compared with Standard Care in Rural Communities

ตนทน-ประสทธผลของการดแลผปวยโรคไตเรอรงระยะ 3 และ 4 ดวยวธแบบผสมผสานเปรยบเทยบกบวธมาตรฐานในชมชนชนบทอรรถสทธ ศรสบต พ.บ., วท. ด.*, ธรยทธ เจยมจรยาภรณ พ.บ.**, เมธ จนทรพทกษกล พ.บ.**, วนย ลสมทธ พ.บ.***,วชรพงศ วศาลศกด พ.บ.****, สชญญา พรหมนม วท.บ.***, ละออ ศลานกรม วท.บ.****, พกล มทรพยทอง วท.บ.*****,อรณ ไทยะกล สม.*, ปราณ บดรฐ วท.บ.******, ศลยเวทย เลขะกล พ.บ.**, เกรยง ตงสงา พ.บ.********สถาบนวจยและประเมนเทคโนโลยทางการแพทย กรมการแพทย**สถาบนโรคไตภมราชนครนทร***โรงพยาบาลคลองขลง จงหวดกำแพงเพชร****โรงพยาบาลทรายทองวฒนา จงหวดกำแพงเพชร*****โรงพยาบาลกำแพงเพชร จงหวดกำแพงเพชร******สำนกงานสาธารณสขอำเภอคลองขลง จงหวดกำแพงเพชร*******ภาควชาอายรศาสตร คณะแพทยศาสตร จฬาลงกรณมหาวทยาลยAbstract : Cost-Effectiveness of Integrated Care in Patients with Chronic Kidney Disease Stage 3 and 4 Compared with Standard Care in Rural CommunitiesSrisubat A*, Jiamjariyaporn T**, Chanpitakkul M**, Leesmidt V***, Wisansak W****,Promnim S***, Silanukrom L****, Meesupthong P*****, Thaiyakul A*, Bodeerat P******, Lekagul S**, Tungsanga K********Institute of Medical Research and Technology Assessment, Department of Medical Services, MoPH;**Bhumirajanagarindra Kidney Institute, Bangkok;***Khlong Khlung District Hospital, Khamphaeng Phet Province, MoPH;****Saithong Wattana District Hospital, Khamphaeng Phet Province, MoPH;*****Khamphaeng Phet Hospital, Khamphaeng Phet Province, MoPH;******Khlong Khlung District Public Health Office, Khamphaeng Phet Province, MoPH;*******Department of Medicine, Faculty of Medicine, Chulalongkorn University(E-mail : asrisubat@gmail.com)Chronic kidney disease (CKD) is a major problem in healthcare system of developed and developing countries. In Thailand, most patients are continually treated at district hospitals nearest to their communities. We have previously shown that integrated care consisting of multidisciplinary care team (MDT) and community care network (CCN) was effective for delaying CKD progression. This study aimed to assess cost-effectiveness from societal perspective of integrated care compared with standard care for CKD stages 3 and 4 patients. We performed a decision tree model for two years in this comparison with 3% discount. Participants’ costs and quality of life in term of utilities were collected from Khlong Khlung District Hospital and Saithong Wattana District Hospital, Khamphaeng Phet Province. The progression to end stage renal disease (ESRD)of both groups at two years was calculated using data from the Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand Study (ESCORT study). The findings revealed that participants’ ages were similar in both groups, most of them were female. The unit cost (per person per year) of integrated care and standard carein healthcare provider’s viewpoint was 7,398 and 5,889.84 Thai Baht (THB) respectively, whereas utility per person were 0.74 and 0.70 respectively. We simulated 60 CKD stages 3 and 4 patients in each group and found that the 2-years total costs were 1,048,278.20 THB in the integrated care group and 778,209.76 THB in the standard care group. The incremental cost perESRD averted and per utility gained were 126,792.70 THB and 224,764.84 THB respectively. In conclusion, integrated care in patients with CKD stage 3 and 4 in rural communities was not cost-effective when compared with standard care based on World Health Organization’s recommendation criteria. However, the sensitivity analysis showed that integrated care would be cost-effective if its direct medical cost could be reduced by a half.